Local Government and Public Involvement in Health Bill

My Lords, I confess that I had not expected to be standing here winding up today, but it has been a real privilege to have listened to such an excellent debate. My noble friends and I look forward to debating this issue further in Committee. We all hope that my noble friend Lady Andrews will be back in full voice before Committee stage; I certainly do. It is with some trepidation that I attempt to respond on these important matters of local government to so many experts in the Chamber today. Like the noble Baroness, Lady Cumberlege, I have local government experience—I was a member of Oxford City Council at the age of 24—but that was quite some time ago. It would be foolhardy for me to attempt to respond using that experience, gained way back in 1973. There was a sense, when I listened to some noble Lords, of a golden age of local government freedom when central government were content to hand out the money and let local government get on with it. I can assure noble Lords that back in 1973 and 1974 we were talking, as ever, about too much control by the centre. This has been a tension in British governance for many years. I see the Bill as an encouraging shift towards much greater local determination. I will come back to that shortly. Although a number of noble Lords have expressed disappointment about the pace and scale of the greater responsibility that local authorities will have, we should not undermine the significance of what is in the Bill. My noble friend Lord Graham said that he was disappointed with the tone of some of the criticism. I hope that we will not get a thousand amendments, as he implied. It is clear that we will have a very engaged Committee stage and I will write to noble Lords on the points to which I will not be able to respond in a 20-minute wind-up speech. Like other noble Lords, I pay great tribute to the noble Baroness, Lady Campbell, and the noble Lord, Lord Mawson. We are all agreed that their maiden speeches were splendid and we look forward to their continued involvement in this and other Bills. I am ever sympathetic to the proposals of the noble Baroness, Lady Masham, on garden centres, although I fear that we will all spend even more money in them if she has her way. My noble friends Lord Smith and Lady Jones spoke eloquently about the progress made by local authorities and the enabling nature of the legislation. I am sure that my noble friend Lady Jones was right when she talked about the need for local government to have more community engagement and citizen empowerment. Although being elected is very important in terms of local democracy, it should not end there. I commend to her the work of the Roberts commission in looking at ways to involve more people in local government. In my city of Birmingham, the Young People’s Parliament engages young people in local government matters. There is much that we can build on. I echo the words of the noble Lord, Lord Mawson, about the need for stronger partnerships between local authorities and community enterprises. I see that as very much part of the devolution package. The noble Lord, Lord Bruce-Lockhart, talked about the progress that has been made by local authorities over the past few years. I agree with him. I also agree that we need to move away from an era of many central targets to one where there is much more local ownership by local authorities. That is what we are seeking to do in the revision and reform of the best-value regime. Although concerns have been expressed about the number of targets in the health service, I think that they are needed to get local government and the health service into the right place and to see the necessary improvements made. I doubt whether some of the improvements to which noble Lords have referred would have taken place without the central direction and targets. Having got there, I think that now is the time to move on, and the Bill is a very important statement of how we will do that. Local area agreements, working with partners, the wider power of scrutiny, the requirement for partners to have regard to co-operate, comprehensive area assessments, less upward and more outward, and the 35 local improvement targets to be negotiated instead of being set in a top-down approach—all these go to the heart of what the Bill is about. The noble Lord, Lord Bruce-Lockhart, to whom I pay tribute, talked about the link between disadvantaged communities, poor educational and health outcomes and worklessness. He graphically described the power of this approach through local area agreements. I remember when he visited Ministers at the Department for Work and Pensions and we talked about the potential for a partnership between Jobcentre Plus and local authorities. If we can get the health service, the police and the other statutory agencies agreed on a local plan to look at disadvantaged communities or health issues, the power of that partnership could be enormous. Surely the Bill’s important message is that local authorities will be in the leadership position. Many noble Lords will know my father-in-law, John Stewart, a professor of local government who was in local government for many years. He used to talk about the enabling local authority. For me, this is what an enabling local authority is all about. It is concerned not just with running its own services and its own statutory provisions, but with taking the lead, working with other agencies and adding value to its local authority area and the people living in it. That is why I do not agree with the noble Viscount, Lord Eccles, and do agree with the noble Lord, Lord Best. I see this as a turning point towards devolution. I accept that it does not go the whole way, but it is a critical step. This debate is largely about devolution; all noble Lords who have spoken have talked about its benefits. For most of the time I spend in this Chamber and as a Minister, people do not come to me and ask for devolution. The great thrust of our debate is about the need for central action. We have to address this because if devolution is to be meaningful, we all have to temper our approach to the demand for central government to take action. Central government action is not taken in a vacuum. We will shortly be debating the Mental Health Bill. The thrust of debate on that Bill has been about central direction and instruction to the health service locally. Getting the balance right between central direction and local determination is not easy. If we recognise that tension, we are much more likely to come to a satisfactory conclusion. Moving to a position of designated targets that are negotiated by the local authority, working with partners and with the Government, seems a way of balancing this tension. The debate on two-tier local government was fascinating. My experience in Oxford was that, compared with being a county borough, being a second-tier local authority was not particularly satisfactory. I think that we were right to take a voluntary approach to structural change, but I accept, as the noble Lord, Lord Greaves, suggested, that where district councils are to continue, it is important that they are seen to have an important role and that they are recognised appropriately within the local area agreement and the partnership structures. That is what the Government are seeking to do. Let me say to my noble friend Lord Dubs that, in terms of the broad cross-section of support, we recognise that proposals may not carry a consensus from or within all sectors. But authorities were asked to provide a range of support from key partners and stakeholders. My noble friend Lord Clarke spoke about Burnley, and I understand the disappointment felt about the decision. The reason for it was laid out in the decision letters, to which I refer my noble friend. We have said that we have no plans for a further round of restructuring, which answers the point raised about stability. However, the Bill provides for a further invitation to councils to come forward with unitary proposals. There may, for example, be a case for inviting a council to make a proposal where that might be necessary to make sense of a boundary change. My noble friend was concerned about the primary care trust. There is nothing in the Bill that should jeopardise the very good work that he described early in his speech. The Bill gives powers to move to whole-council elections. If a local authority was originally what is called a ““partial council””—in other words, it elected members by half or by thirds—it will have the power to move back. Voluntary organisations are not designated as statutory partners, because that would have the serious consequence of binding local authorities. It would burden them with a range of responsibilities that they may not want or be able to meet. I understand that we will come back to that matter in the future. The scrutiny role gives to back-bench local authority councillors an enhanced and valuable function. I draw noble Lords’ attention to the value of some of the OSC reports in the health service. They have been of high quality and enormously influential. They show us the way forward for local authorities. My noble friend Lord Smith spoke about the potential in this area. I have no doubts whatever, particularly in relation to health and social care, about the value of having those services around the table within the local area agreement and making them much more of an integral part of OSC responsibilities. It offers huge advantages for the future. Perhaps I may offer to write to the noble Lord, Lord Roberts, about Wales. It is the Government’s policy to draft Bills in a way that translates legislative competence to the National Assembly. This is an England and Wales Bill, so the provision for Wales is entirely appropriate. My understanding is that the Order in Council route will be taken where no suitable Bill is in the legislative programme. I understand also that the provisions were widely discussed and enjoyed cross-party support in the National Assembly, but I am happy to write to the noble Lord further on that matter. The noble Lord, Lord Boston, made an eloquent point about freemen of the ports, to which I have no doubt we will return in Committee. I turn to the health service. It is perhaps not surprising that noble Lords reminded me of my own heroic role in legislation on it. They will know that I started my career in the health service as a CHC secretary, but we were right to move on from CHCs. We can very kindly say of them that they had a patchy record. After 25, nearly 30, years, they had reached the end of the road. We saw patient forums as a way of moving on to match the agenda for the health service. I pay tribute to the work of those 4,000 to 5,000 dedicated people who have sat round the table of the patient forums and who frankly have not always had the support that they could have expected from the Commission for Patient and Public Involvement in Health. We should not run away from the fact that advice was given to some patient forums that names were confidential and could not be released because of data protection. Nor should we run away from the fact that advice was given to some patient forums that they should not meet on health service premises because that would be regarded as a conflict of interest. It has been absolutely right to move on. We want to reflect the changes in the health service and in local government. That is the huge advantage that LINks brings. Noble Lords have not remarked on the fact that, for many years, CHCs wanted responsibility in social care. LINks gives that responsibility; it opens up opportunities for much more intensive monitoring by local people of the health and social care interface and for their showing concern for it. That will be an enormous advantage. We of course want to build on the work of patient forums and to encourage as many of their members as possible to take part in the new LINks. I say to the noble Lord, Lord Walton, and the noble Baroness, Lady Neuberger, that they of course have a huge role to play in enhancing and informing the commissioning role. Many comments were made about the arrangements for a host organisation. I make no apology whatever that this is being done through local authorities. We cannot have it both ways. We have spent half this debate praising local government and the role that it wishes to take. In the other half, we have expressed doubts about whether local authorities should be given this responsibility. We should trust local authorities to do the job properly. Who is best able to ensure that the contract with host organisations is effective and is monitored, and that the money is handled successfully? I cannot think of a better way of doing it. It will be done by a local authority instead of a health service body to ensure that there is not a conflict of interest. Since the resources that will be made available will be spent at local level rather than in a national or regional structure, which is what has happened with the Commission for Patient and Public Involvement in Health, the host organisation will be able to spend much more resource directly in support of the new LINks. I know that the noble Baroness, Lady Neuberger, disagrees, but providing relief from the responsibility for employment and all the other administrative duties, and having a local councillor voluntary service, for example, providing the support, will give tremendous support to those LINks. We hope that hundreds of people and many local organisations will come together to agree a governance structure. Yes, it is true that I cannot answer some of the questions that were asked by noble Lords. That is because the whole point of what we are seeking to do is to give much more discretion at local level, which, again, is the very thing that noble Lords said that they wanted for local government in this debate. The whole process and the guidance that we will give will be informed by the nine early adopter sites that are now in operation. We will be informed by what is happening at the moment. That will inform the guidance, and that will ensure that we give as much discretion as possible. However, we can rely on local authorities, through the contract with host organisations and the guidance that we give, to ensure that due process is adopted. There are many other points to which I would like to respond now, but we can cover them in Committee. I should like to turn to the issue of visiting. Why do we want co-ordination of visiting? We want it precisely because of the point raised by the noble Lord, Lord Walton, about the 58 organisations that have access, monitoring and visiting rights. On spot visits, my judgment is that that role must rest with the regulator. However, we will listen very carefully to what noble Lords have to say on this matter. The noble Baroness, Lady Neuberger, made a good point about the regulators perhaps using LINk members in some way. I shall certainly take that back to the regulatory bodies. There is nothing sinister in making sure that consultation is significant. We are seeking to ensure that there is absolute clarity in the health service about what falls within the statutory consultation process and what does not. I am sure that we can share more on that in Committee. I see no conflict whatever regarding foundation trusts. I am a member of the Birmingham mental health foundation trust and I hope to join the Birmingham LINk. I do not see a conflict here; the more people who can be involved, the better. For example, there is no reason at all why LINks should not decide to have a review of mixed-sex accommodation in the health service—a point raised by the noble Baroness, Lady Cumberlege—and issue a report on it to which the health service would have to respond. We will have splendid debates in Committee and in stages beyond that. I shall write to noble Lords on the points that have not been answered in the debate. I thank all noble Lords who took part in this highly interesting and constructive debate. On Question, Bill read a second time, and committed to a Committee of the Whole House.