Local Government and Public Involvement in Health Bill

My Lords, I beg to move that this Bill be now read a second time. Noble Lords who were involved in the Greater London Authority Bill late last night will be well aware of the valiant efforts made by my noble friend Lady Andrews to speak through a very difficult cough—which I am afraid has made it impossible for her to address the House today. However, we are very much looking forward to her joining us for the remainder of her Bill. I am looking forward alsoto the two maiden speeches which we will hear later from the noble Baroness, Lady Campbell of Surbiton, and the noble Lord, Lord Mawson. The Bill is about greater devolution of power to local government and greater local democracy. As such, it reflects a vibrant public debate which has called for a shift in power away from central government and towards local government and the citizen. The Bill is therefore perhaps more radical in the changes it will bring than it may seem—changes not only in the organisation of local government and the work of councils and councillors but in the culture of partnership and the shaping of local services. It is driven essentially by the aspirations and experience of local government itself. The Bill is essentially pragmatic. It is driven by what changes have worked well and by a two-year conversation with local authorities and partners across England which culminated in the White Paper. The Government have continued to listen intently and that is reflected in the many changes made in the other place which have strengthened local control in different ways. In that respect this Bill is significantly different from every other local government Bill that has come before this House. Quite simply, we seek to build on success. I begin by celebrating the great improvements that have been made in the quality of our local public services over the past decade. Homelessness is at its lowest since the early 1980s and housing supply has increased by over one-third. Nearly 80 per cent of authorities are now rated good or excellent. We have increased funding by 39 per cent in real terms since 1997, and every local government in England now has a local area agreement providing increased flexibility for local government and partners. These improvements have been achieved by local government but they have been largely and deliberately driven from the centre. Now we need to change our approach and give local authorities and partners the freedom and space that they need to shape and make places for the future. That is increasingly seen as the defining role of local government and it is a role that needs to be strengthened. The Bill will make local authorities more powerful and more visible. Part of the challenge for local government now is to work more strategically and particularly to work closely with health partners to take greater shared responsibility for delivering more coherent services. That is why, throughout the Bill, we address how health fits into the picture. Crucially, we are giving a stronger voice to local people, whether in the ability to create new parish councils, to seek greater help from councillors or to have new rights to be informed, consulted and involved. I will outline the key themes of the Bill; five key elements will strengthen local government. These are set out variously in Parts 1, 3, 4 and 5. First, authorities in two-tier areas will be enabled to propose a move to simpler structures. This will be matched by promoting better partnership working in the remaining two-tier authorities. Secondly, we shall build on successful models of strong local leadership. Thirdly, we shall remove the power of the Secretary of State for traditional and specific responsibilities, for example in relation to the creation of parishes. Fourthly, we shall create a better, more proportionate way of ensuring and measuring local improvement. Fifthly, we shall create a transparent way of agreeing between central government and local government and its partners a small number of core priorities specific to each locality which cover the social, economic and environmental needs of local areas. One of the most profound challenges we face is to create greater knowledge and confidence in local government, not least so that improvement is recognised and to make the work of local government immediate and relevant to people. There is no doubt that however effective it may be, the complications of a two-tier system of local government makes this much more difficult. Eighteen months ago, therefore, we invited councils to tell us what was working and what was not, and what they wanted to improve and change. In a number of areas there is determination to make the two tiers work better. However, in some areas there is a strong feeling that the current system cannot be made to work and that the unitary option makes more sense. We have responded to that. This Bill puts in place a procedure for voluntary structural change. This is not about change for change’s sake; it is about improving accountability and leadership, increasing efficiency and achieving better and more responsive services for communities. I shall explain the process and the timetable. The timetable is driven by a full recognition that proposals for restructuring can create uncertainty and tensions. That is why we are committed to progressing towards implementation as soon as possible. The invitations for proposals were issued last October. As a result we shall be able to move towards implementation quickly, with new unitary authorities up and running byMay 2009. We are consulting on 16 proposals for unitary structures. Each of these proposals was judged against strict criteria, including the need to show that there is a broad cross-section of support, affordability and value-for-money services. The Government’s assessment was that there was at least a reasonable likelihood that those proposals, if implemented, would meet the criteria. The consultation closes on 22 June. Decisions will be made at the end of July. I want to address a related point. In the other place there were concerns about the Secretary of State’s power to direct councils to submit proposals for unitary structures set out in Clause 2. Working with the LGA, we have therefore made amendments in the other place so that now this power can be used only during a narrow window. In addition, my right honourable friend the Secretary of State indicated at Second Reading that we would use this power to deal only with residual areas in order to ensure that a proposal received in response to our invitation and which we are minded to implement, works properly for the whole area concerned. I am pleased to be able to reiterate this commitment publicly today. Clearer local responsibilities need to be matched with clearer local leadership and clearer accountability. I am pleased that the noble Lord, Lord Heseltine, recognised the value of strong local leadership and direct elections in his interim report from the Cities Taskforce. Improving local areas has never been more difficult. It seems that we are in agreement that council leaders need the power to take tough decisions and to develop and communicate a clear vision for their area. While the best leaders can be successful in any system, the evidence shows that executive governance arrangements are most likely to lead and support the strong and accountable leadership that places need. We are confident that the three executive models set out in the Bill will provide this leadership. The three models are an elected mayor, an elected executive and a leader and cabinet executive. The small number of authorities that because of their size have opted to operate alternative arrangements will continue to be able to do so if they choose. Where an authority has a leader and a cabinet executive, executive powers will be vested in the leader, who will be able either to exercise the powers himself or herself or delegate them. We will expect a council’s constitution to continue to explain which functions are to be discharged by the executive. Overview and scrutiny committees will be able to investigate the way in which executive powers are used. Functions that legislation or a council’s constitution require to be discharged by the full council will be unaffected and will continue to be discharged in the usual way. We are greatly strengthening powers of scrutiny so that they extend beyond the council. For the first time, overview and scrutiny committees will have the power to require information from certain key local powers, which will already have an enhanced role in the making of community strategies and local area agreements. Those local partners will be required to have regard to the reports and recommendations that the committees produce. The third area of change will increase the autonomy of local authorities, for example by transferring the responsibility for decisions on the electoral cycle of a local authority from the Secretary of State to local government. We are taking the Secretary of State out of the equation in relation to community governance and by-laws. We are increasing local ownership of conduct issues by devolving most decision-making on conduct to local authorities. Crucially, we are also devolving powers to the National Assembly for Wales to enable Wales to legislate for itself on a range of local government matters covered in the Bill. The conversations that we have had with local government have made it clear to us that they and their partners spend too much time addressing the requirements of central government rather than those of citizens and communities. That is why we are seeking through the Bill to increase the ability of local authorities to determine and focus their own local priorities. The best value regime will be streamlined and will sit alongside a completely revised framework for monitoring and reporting on local authorities’ performance. The number of national indicators will be reduced from 1,200 to a robust set of 200 indicators that will focus on outcomes and will make sense as local priorities. That will be complemented by a new comprehensive area assessment system that will focus less on upwards reporting and more on identifying risks to service delivery in an area and on citizens’ experiences. Other changes will bring local authorities into a new and more effective connection with other local partners that are responsible for the well-being of the community. That partnership has already been enhanced by the local area agreements in every local authority, but the local area agreements have been too limited to reach their potential to become the delivery plan for the whole sustainable community strategy, which is the sum of the needs and aspirations of the whole community. The Bill makes this possible by expanding and strengthening the role in two ways: first by placing them on a statutory basis and secondly by extending their coverage and partnership, so that they become the sole delivery agreement for the issues which local authorities wish to tackle on their own or in partnership with others; such as community safety, childhood obesity or economic inactivity. I shall explain how this process will work in practice. Each responsible local authority, its partners and the relevant government office will identify the core challenges facing each local area. Against these priorities will be set around 35 local improvement targets, although in some areas there may be fewer. These will be designated targets and will be set against the 200 or so national indicators. But the local authority and its partners will also be free to set other local targets, should they wish to do so. Most significantly, we are placing a statutory duty on key public agencies to co-operate. This will give local authorities the levers that they need to bring together all the key partners in an area to agree the core community priorities for action. These duties will not exclude other organisations from participating in the negotiations or even from signing up to local improvement targets on a voluntary basis. As a result, local people will have a clearer idea of the priorities of their local council, how their needs will be met and who will be responsible. In another innovative step, we are requiring local authorities and primary care trusts to work together to produce a strategic assessment of the health and social care needs of their local population. This will also feed into the sustainable community strategy and, in turn, the priorities agreed in the local area agreement. We are also providing the opportunity for greater flexibility and efficiencies in the delivery of waste services—both collection and disposal—through powers to allow the voluntary establishment of the statutory joint waste authorities. We want to improve the relationship between local government and the local community by amplifying the voice of the local community and giving more scope for local councillors to champion their interests. We are also placing a statutory duty on English best-value authorities to inform, consult or involve representatives of local people—for example, through newsletters, posters and neighbourhood forums. Of course, many best-value authorities already do a great deal to involve and consult citizens and communities, but we want to ensure that all people, irrespective of where they live, work or play, have opportunities for involvement. We are adopting a similar approach with regard to the health services by strengthening the existing requirements on NHS organisations to consult patients and the public in the planning and development of health services. Local people will also have a louder voice in another way. We are introducing the Community Call for Action, through which a councillor will be able to refer an issue to an overview and scrutiny committee and require a response. That brings me to the final element of the Bill that I want to discuss. The fact that it is at the end of the Bill and confined to a single part—Part 14—does not diminish its importance. We can see by the number of speakers who have an interest in health that this is held up in your Lordships’ House as well. For several years, we have been engaged in trying to ensure that patients and the wider public are properly involved in their local health services. Patients’ forums, which we debated in this House in 2002, moved patient and public involvement on, raising its profile and producing many success stories. I pay tribute here and now to the hard work, expertise and enthusiasm of patients’ forums throughout the country. As I shall make clear, we feel that it is essential that the energy and expertise of the forums, far from being lost, must be captured within the new local involvement networks. I shall explain the key features set out in A Stronger Local Voice, published in July 2006, which was based on a nine-month review of patient and public involvement. The changes that we propose are, first, to make patient involvement genuinely local. It will no longer be confined, as patients’ forums were, to single institutions such as acute hospitals or PCTs, but will cover all services provided across the whole local authority area. Secondly, they are intended to involve more people: not just individuals, as patients’ forums did, but networks and organisations so that patients’ voices are heard from many different and organised perspectives. Thirdly, they will cover social care as well as health. LINks will be established for an area and, for the first time, will consider all the health and social care services used by people within the area. This is a huge advance. Why do we believe that these changes are necessary? First, without wishing to diminish the work of patients’ forums in any way, there have been significant new configurations in the health and social care system, not least the move towards greater coterminosity between PCTs and local authorities, and greater joint commissioning across health and social care. But more importantly, the experience of many patients is that they cross services as they require care; for example, a stroke patient may experience services that range from care in an acute hospital, a specialist stroke unit, a rehabilitation unit and then they may need social care. Therefore, if local people are to have a key voice, it makes sense that they are able to speak up on all these stages and issues. LINks will be able, by virtue of their role and larger membership, to consider the whole patient journey. So LINks will do the following things. Their role will be to collect the voices of the local area with regard to health and social care services across the sector; to monitor the range and quality of care services; to consider, report on and make recommendations about all relevant services; and to promote greater public involvement. To allow them to do that effectively, properly trained members of the LINks will have a power to enter and view services, just as the patients forums do now. That will include health and social care premises as appropriate. How will they be organised? The Bill requires local authorities to make contractual arrangements for the support of these networks: procuring an independent host organisation, well versed in health and care issues, and likely to be from the voluntary and community sector, to support the LINk in carrying out its activities to facilitate user involvement. The Bill, deliberately, does not set out detail of size and shape of membership or governance. That must be the responsibility of the LINk organisation itself; we will support the process by providing model contracts and guidance, but that must be locally owned and designed. Currently, there are nine early-adopter schemes which are not pilots, but areas which are working through these issues. Their experience will inform our guidance and the support we will give the emerging LINks. LINks will be independent, as are patient forums. They will build on the best work of patient forums and we would encourage all forum members to become involved in their LINk, as the experience they have built up over the past three years will be invaluable to the success of the new system. As I think you can see, these changes are driven by a genuine desire to involve more people. They will be locally hosted and driven and they will set their own priorities locally. In conclusion, you will no doubt agree that this is a wide-ranging Bill. So much so that there are some elements that time does not permit me to cover, but I hope I have demonstrated how seriously we are taking this opportunity to give local government, local partners and local people the tools and support they have asked for. We are putting the trust in local government and communities to find their own solutions that best respond to local needs and to shape their own agendas. It is for them to rise to the challenge going forward. I should note that we still have some improvements to make to the Bill, and we will be bringing forward some amendments in Committee. Indeed, we have received a most helpful report from the Delegated Powers and Regulatory Reform Committee, to which my noble friend Lady Andrews will be responding. It may be that we will wish to bring forward some amendments to address their recommendations. I look forward to robust debate on the Bill, both today and in the coming weeks. I commend the Bill to the House. Moved, That the Bill be now read a second time.—(Baroness Morgan of Drefelin.)