Local Government and Public Involvement in Health Bill

This is an important group of amendments because it focuses on the role of the Secretary of State and the degree of power in designating local improvement targets and the balance of power between the responsible authority and partner authority in changing local improvement targets as part of revision proposals. They are clearly two areas of concern. I will not reiterate everything I said earlier about the making of targets, as I went into that in some detail. All I will say is that we are trying to ensure that all signatories to the agreements, whether it is the Secretary of State, the responsible authority, a named partner, or another voluntary partner, are treated appropriately in the whole process of determining, refining, submitting and revising targets. We know that the LAA will comprise a series of local improvement targets, which will have been agreed to, and through that process partners around the table will have identified their local priorities and set targets against them. In doing so, they will have identified which local targets are drawn from the core national policy priorities as identified in the national indicator set. When the draft LAA goes to the Secretary of State, via the government office and has been approved, the Secretary of State on behalf of the Government collectively will formally ““designate”” those targets which are of key national importance and which will have been drawn from the national indicator set. So it is working from the bottom upwards in an iterative way. As I have said, those designated targets will hardly come as a surprise because people have been looking at the indicator set, looking at their local circumstances and relating the one to the other. The local improvement targets within the LAA that are not designated remain in the LAA and, vitally, they have equal weight in the agreement; hence the named parties remain under a duty to have regard. They can be amended without the consent of the Secretary of State and will not be reported on to central government. Local improvement targets, which have been signed up to voluntarily by partners who are not named partners in the Bill, are also part of the LAA, but those partners, as we agreed earlier, are not bound by the duty to have regard to the targets. That is the model and those are our expectations. This group of amendments, therefore, seeks to differentiate from the outset of the LAA negotiation those targets which are of national importance and those which are of purely local interest, and to treat the two sets of targets very differently throughout the process. However, the distinction between national targets and purely local ones will not always be clear cut. Let me explain. They will need to be teased out in negotiation. For example, Sheffield is in the current feasibility testing. It is looking to tackle health inequalities in relation to the 2010 life expectancy target. The target may be one included as one of the national indicator set. That would make sense as life expectancy is a large target. However, Sheffield has already met the national target and, as such, it may not be designated. There is no need for that. As it wants to continue improving health inequalities in the area, it could include a more stretching or demanding target in its LAA as a local improvement target. That is a way of demonstrating that the LAA is a mechanism not just to address areas of poor performance—to catch up—but also to deliver greater local ambition. Amendment No. 209A, which we discussed in a previous group, has a bearing on Amendment No. 211A. It sought to define national improvement targets as, "““a national target for improvement designated by the Secretary of State in respect of which there shall be a maximum number of 35””." That amendment and Amendment No. 211A, which would require the Secretary of State to designate national targets only at approval stage, would be unworkable. Amendment No. 209A defines a national target as one that has been designated, while Amendment No. 211A would allow the Secretary of State to designate only a national target; that is, one that has been designated. The process would be circular, and we must be careful not to fall into that sort of trap. The bulk of the amendments involve the notion of identifying national targets prior to approval. Amendments Nos. 212A to 212C, 212F, 212G, 212J, 212L, 212Q, 212R and 214A seek to distinguish, prior to approval of the LAA, targets of local as opposed to national interest, and would confine the Secretary of State to the national improvement targets. This would mean that local partners would need to specify which targets in the LAA were of national interest, which would remove the power of the Secretary of State to designate any LAA local improvement target. We would expect the distinction between purely local targets and the small number of national priorities to emerge during the negotiation. However, given the importance of LAAs and the fact that this is the only place where the Secretary of State and local authorities will come together to agree on where the national indicators actually relate to what the local authority is trying to do, it is surely important that the Secretary of State retains this discretion as a backstop to ensure that the right national priorities are reflected. We intend to set out in guidance the practical clearance steps for the LAA so that everyone is clear about what the process will look like. The LAA will evolve out of the process of negotiation. On the revision of targets, the effect of Amendments Nos. 212D, 212H, 212K, 212M, 212N and 212P would be that the Secretary of State could designate only national improvement targets. Local improvement targets would therefore be handled exclusively by local partners, who would be the only parties who could amend, add or remove local targets. This would mean removing the power of the Secretary of State to designate any new local improvement targets as part of a revision proposal. Taking away that function, which the Secretary of State exercises at approval, from the revision procedure would severely limit the flexibility of the LAA to respond to changes in national priorities in the lifetime of an LAA. There may be a critical development in, say, climate change, so obviously there need to be some flexibility. The local authority may not choose to take on that new target as part of the LAA and may well have to be prompted by Secretary of State to see the significance of any change and how it might be managed locally. Amendment No. 212BA would remove Clause 112(2), thereby allowing local authorities to change targets outside the revision process and thus removing the Secretary of State’s involvement. To allow targets to be altered much more flexibly not only affects the Secretary of State’s role to designate revised targets but provides for the alteration of designated targets by named partners. Removing this provision would greatly weaken the Secretary of State’s ability to ensure that the LAA responds appropriately to changes of circumstance. Again, we would be back in the situation that I described previously. Amendment No. 212MA is consequential on Amendment No. 212H, which I have already discussed. Next we come to the balance of power between responsible or partner authorities and targets. The Government agree with the effect that Amendment No. 212E would have. The amendment would allow a local improvement target to be changed or removed with the consent of all partners to which the target relates. I completely agree with that measure, which is why we have already made provision for non-designated targets in Clause 112(4) and (6). Therefore, the noble Lord’s amendment, although admirable in principle, is unnecessary. I reiterate, however, that the situation is different for designated targets because they reflect targets of national importance, so the Secretary of State retains the function to approve any changes made to those targets. That distinction must hold. Finally, the effect of Amendment No. 212C would be that a responsible local authority could amend or remove a non-designated target only after consulting every person to whom the target related. The local authority would not have to seek the consent of every person as is currently the drafted provision. There is a good reason for providing as we do that undesignated targets can be changed, but only with the consent of each person to whom the target relates and having consulted such other persons. If a target relates to a named partner, it is under a duty to have regard to it. Therefore, it is only reasonable that if a duty is placed on a named partner, that partner authority surely should consent to any change affecting a target for which it is under a duty to have regard to. For example, if a local business or charity voluntarily signs up to a target, it is not under a duty to have regard to it, which is why it needs only to be consulted, but it should not be able to veto change as it is not subject to the same duty to have regard as a named partner. In Committee, we have talked a lot about balance. In this arrangement between the Secretary of State and the local authority, between the designated targets and the local targets, we have tried to have coherence and a balance of responsibility with the essential impulse driven by the experience and expectations of local authorities. Although this set of amendments and my response are rather complicated, I hope that noble Lords will be satisfied.