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Baroness Carnegy of Lour: My Lords, reading the clause, it struck me that something rather strange may happen. Paragraph (4)(b) states that the Secretary of State may by order,
- "abolish a Strategic Health Authority".
Lord Hunt of Kings Heath: My Lords, I warmly welcome the positive remarks that noble Lords have made about the clause, which I find most encouraging.
First, the noble Earl, Lord Howe, was arguing two points. In the first stage of his argument, he suggested that strategic health authorities would be control freaks. We shall come to later amendments proposed by him and by other noble Lords, the overall thrust of which is to give strategic health authorities more power and to take it away from primary care trusts. That would be a great pity. We are not dealing with a
proposal to micro-manage the health service. We are at the start of a process of massive decentralisation to the primary care level within the health service.I turn to the Statement made by my right honourable friend the Secretary of State for Health in another place on the day after the Budget. He said that our intent is to,
- "go further in extending devolution in the NHS, building on what has been achieved . . . The health service should not and cannot be run from Whitehall".—[Official Report, Commons, 18/4/02; col. 715.]
Later, we shall discuss the role of organisations such as the Commission for Health Improvement. The whole point is that the structure that we are setting up will establish clear national standards and an independent inspectorate—the context within which we can then devolve decision-making to the local level far more than has ever happened before. If we have a foundation of national standards and an independent inspectorate, we will be able to devolve in the way that we seek.
Several questions were raised about the role of strategic health authorities. It is tempting to go through the list of their functions, as we did in Committee, but it would be better for me to resist that temptation. I am satisfied that the size of each strategic health authority is about right. It is pitched at a population of about one and a half million for each. I say to the noble Lord, Lord Clement-Jones, that that is small enough for them to retain a local connection but large enough to allow them to cover the kind of areas that we want for our care networks.
The noble Lord will recall the example of cancer networks in which the planning of services—primary, secondary and tertiary care—goes beyond existing NHS organisational boundaries. The boundaries of strategic health authorities will, in the main, cover those care networks. That is a persuasive argument for the type of boundaries that exist for the 28 health authorities that we have established, which will become strategic health authorities.
The people who have been appointed as chief executives of the strategic health authorities are of a high calibre. To the noble Earl, Lord Howe, I say that they know as well as we do that the importance of their role lies not in being heavy-handed or behaving like control freaks; it lies in being sensitive to the need to give as much room as possible to NHS trusts within their boundary to work as flexibly as possible while being able to intervene when things go wrong and co-operation is not working as required.
The existence of such reserved powers is not evidence of control-freakery; it is a sensible way of ensuring that there is a performance management system that allows the strategic health authorities to intervene in the kind of issues about which the noble Earl is concerned. His examples of teaching, research and specialist services are ones with which I agree. The success of the proposals will be in ensuring that such intervention is minimal.
The noble Earl, Lord Howe, also asked about potential disagreement among strategic health authorities about priorities and about the future development of services. The people running the authorities are grown-ups. They are paid quite well for what they do, and they include some of our most senior people. I would expect that, by and large, they will be able to reach sensible agreement. Of course, there may be occasions on which that will not be possible. On such occasions, I would expect that the directors of health and social care—we have one director of health and social care for each quarter of the country, four in all—will be on hand as trouble-shooters to broker a sensible resolution of disagreements, although I do not expect that they will happen frequently.
The noble Earl, Lord Howe, raised the question of the SaFF process, the customary round of agreement between health authorities and NHS trusts about the money to be spent in the forthcoming financial year. My experience of the process is that there will always be tensions between those who commission services and have the money and those who provide the services and want the money. We should not worry too much about noises emanating from the health service at the moment. In my time working in the NHS or observing it, I cannot recall a year in which there were no tensions in the SaFF process. Inevitably, under the new arrangements, there will continue to be such tensions between primary care trusts, which will hold most of the budget, and other trusts. However, those tensions detract from the overall structure that we have put in place.
Our purpose is to devolve to the primary care level. That is why I shall resist some of the amendments to be proposed later today that would wrest power and control from primary care trusts and place them with strategic health authorities.
I understand the general points made by the noble Lord, Lord Peyton of Yeovil, about the structure of the Bill and the way in which some of the clauses have been written. He will know that I have some sympathy with his view. I wrote to the noble Lord informing him of the Government's intention to endeavour to consolidate NHS legislation in due course. There is, in the House of Lords Library, an amended version of a working version of the National Health Service Act 1977, as amended by legislation up to the Health and Social Care Act 2001. I understand that that does not entirely answer the point raised by the noble Lord.
3.45 p.m.
Lord Peyton of Yeovil: My Lords, I am obliged to the Minister, if only for his courtesy. I inquired about
this in the Library and the Printed Paper Office. My description of what I required may have been inadequate, but the document was not recognised in either place. I do not recall receiving the Minister's letter.
Lord Hunt of Kings Heath: My Lords, I shall make sure that we send the noble Lord another copy of the letter double-quick. I shall also ensure that the amended working copy of the 1977 Act is made available.
Lord Peyton of Yeovil: My Lords, I would appreciate it very much if the Minister could send me a copy of the letter, if only as an aid to memory. Presumably, it will arrive long after the horse has bolted and the stable door locked.
Lord Hunt of Kings Heath: My Lords, it is not beyond the bounds of possibility for us to get a copy to the noble Lord very quickly.
The history of the health service over many years includes many efforts by different governments to restructure the health service. The format of Clause 1 follows previous legislation and previous reorganisations. It is good to see on the Benches opposite several Ministers who, in their time, were responsible for restructuring the health service and proposing to Parliament clauses that were similar to that before the House today. All of us who have been involved in the health service will accept that it requires a period of stability during which we devolve more responsibility to local level. That is the intended effect of the Bill. It is extremely significant that 75 per cent of the budget for the NHS is to be devolved to the most local level possible.
Lord Peyton of Yeovil: My Lords, I accept what the noble Lord says; it is the intention that it should be so. However, why on earth does subsection (4) of Clause 1, to which I have already drawn the attention of the House, allow the Government—once having devolved—smartly to go into reverse and either abolish, modify or change in one way or another the authority which has now been established? If these changes were meant to be permanent, one could acknowledge them with some respect, but to make the changes and then say, "I will take them back tomorrow if I want to", is a rather strange way of going about the matter.
Lord Hunt of Kings Heath: My Lords, I do not think that the proposal departs from any principle that has been adopted in health service legislation enabling sensible changes to be made to the boundaries or names of health authorities. I believe that it is sensible to put this power on to the face of the Bill because in a few years' time, who knows whether, as a result of other changes, it might be necessary either to reduce the number of strategic health authorities, or to increase it. There may be reasons why the name might need to be changed. For example, a local authority may change its name. One might then want to change the name of the strategic health authority in order to reflect that.
I can assure noble Lords that, once having established 28 strategic health authorities, the Government do not intend suddenly to decide that we want to make changes. It is intended that the legislation in relation to strategic health authorities should last for a considerable period of time. This provision seeks purely to offer flexibility in the future for any organic changes that may take place in health service provision.
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