Local Government and Public Involvement in Health Bill

I should like to begin by thanking the Minister for the way in which he and his colleagues have taken the Bill through. It was a good Committee, in which we had the opportunity to debate the issues that mattered and to see some changes, while still leaving room for improvement, which enables the Opposition to do their job of chasing the Government a bit harder on things that we believe could be done better. It would be right to acknowledge the spirit in which the Bill has been carried forward, perhaps starting with the witness sessions, which gave us all an opportunity to handle the material in a different way. That was good for Parliament. Some consideration needs to be given to the procedure in that regard; perhaps more time needs to be allowed to get witnesses in place, for example. We were a bit rushed, between the publication of the White Paper and the Bill, but those are minor issues compared with the other matters that we have dealt with. I should also like to thank my colleagues who have played such a stalwart role, especially my hon. Friend the Member for Poole (Mr. Syms), who shouldered so much of the burden. Our colleagues on the Back Benches, my hon. Friends the Members for Ludlow (Mr. Dunne), for Enfield, Southgate (Mr. Burrowes) and for Bromley and Chislehurst (Robert Neill), contributed a great deal to the proceedings. Although he is not here at the moment, I must also acknowledge the extraordinary presence of my hon. Friend the Member for Lichfield (Michael Fabricant), who is a champagne moment all on his own. He contributed not only to the able whipping of the business—with the help of his colleague, the hon. Member for Chatham and Aylesford (Jonathan Shaw), whose contribution to making the wheels turn smoothly we also acknowledge—but to some of the key debates. In particular, we will remember the Lichfield crown jewels for some considerable time. We appreciated his contribution. Is the Bill devolutionary or not? Yes, it is, but the question is whether it is devolutionary enough in the context of the relationship between central and local government. That relationship has changed, and we suspect that there is a demand out there for much more change. The Bill is a move in the right direction, but we think that it does not move far enough in certain respects. It is on that basis that we have divided the House in the past, and it is on that basis that we have made our anxieties felt this evening. It is true that the Bill will need to be considered in the light of the Sustainable Communities Bill, which we believe provides an even more radical model for devolution. We shall be interested to see how far the Government allow it to proceed before pulling the plug, as they inevitably will. In any event, its progress presents a contrast to the way in which this Bill has proceeded, and the ultimate outcome will say much about where local government is going. There have been some welcome developments. On what may not have been the best day for the Minister and his colleagues in terms of U-turns, this is a slightly happier occasion on which to celebrate one or two more U-turns. We are pleased that the directions on restructuring were introduced after we had asked for a degree of limitation on what appeared to be very extensive powers. It took a while, but they finally appeared. It was a shame that the sheer pressure of work and the guillotine meant that we could not deal with them last week, but we appreciated the important concessions that were made—for instance, the concession over the additional partners to be involved in local area agreements, particularly health bodies. We also welcome the enhanced role for local councillors, and the work that has been done on parishes. I think that most members of the Committee could agree on those measures. If I am true to myself and the Opposition, however, I must identify the respects in which we think the Bill fails the devolutionary test. We were never given a chance to debate the big issue of moving powers away from unelected regional bodies to local authorities, which I think remains a blot on the horizon of local government. At some stage that must be faced by the Government, or it will be faced by a different Government. Some issues remain in relation to the restructuring of local government that was attempted by means of the Minister’s cunningly worded invitations to local authorities up and down the country. Some of those invitations were accepted by certain of our colleagues, but we did not see the total meltdown of Conservative authorities that might have been anticipated, and we are grateful to those colleagues who worked hard to prevent it. However, we still feel strongly about the fact that we did not have an opportunity last week to debate whether there should be a referendum in local areas to give the public a say. As we have pointed out before, although the Bill refers to a broad measure of support—or words to that effect—we are not told exactly what that means. I must tell the Minister that I see trouble ahead. When it is a question of how decisions have been made and how a broad measure of support is defined, he will be presented with alternative broad measures of support by competing parties, and contradictory broad measures of support at that. My hon. Friend the Member for Ludlow presented a strong case on the referendums held by district councils in Shropshire, and contrasted that with the decision that had been made here. As I say, I see trouble ahead, because the issue of support has not been properly dealt with. That is, of course, a subject for the judicial review which is still in progress. I noted that the Secretary of State clung to that judicial review a few hours ago, when she was sitting where the Minister is sitting now. Perhaps there is still time for the Government to cling to it again, and to make amendments clarifying how the public commitment will be judged in relation to the restructuring. We shall have to wait and see what happens. We had an extensive discussion in Committee about the executive arrangements. It was repeated tonight, so I will not return to it now. However, I maintain that it might have been better to give local authorities a chance to choose their leadership models rather than having to accept the Minister’s restrictive models, and we still believe that local area agreements could do with a limitation on the number of targets. We listened carefully to the Minister’s argument about flexibility, but local authorities continue to feel edgy about the lack of an upper limit. We would have liked to table an amendment to bring together the police and local government aspects of the community call for action, but I believe it will be raised in the other place, and I hope that the Minister will consider it further. Perhaps the worst part of the Bill is the tagging on of the public health aspects. We will all recall the strength of feeling of witnesses on the abolition of patients forums. The Minister has provided the best defence that he could this evening and in previous discussions. However, it was noticeable that he said a few moments ago that what patients require is the bringing together of local government and health. Well, it was not what they asked for, and it is not what they want. They want a distinctive patient voice, and they think that they have lost that. I still think that the Government have not effectively heard that voice, and this matter will be raised in the Lords. There was criticism: concerns were raised that the local involvement networks will not work. That rings bells: the Government have been warned before that changes might not work—and sometimes those warnings turn out to be accurate. I hope that those LINks are looked at again in another place, and that account is taken of the strength of feeling of patients that they are losing a distinctive voice, because the LINks are too big and they might be dominated by health professionals. The Minister might be gaining from the relationship between local government and health, but patients are losing. There might be another way to address these matters, and if there is I urge the Minister to adopt it.