My Lords, in moving Amendment 36D, I shall also speak to Amendment 36E. Both amendments are in the names of my noble friends Lord McKenzie and Lord Beecham. This is the first opportunity to debate health and social care, but it may not be the last. I declare an interest as a resident of Greater Manchester, former city councillor in Manchester and former MP for the city. My interest in devolution to Greater Manchester is particularly strong.
These are essentially probing amendments regarding the devolution of health and social care to the combined authority—initially to Greater Manchester. I say “combined authority” because it is my understanding that health and social care is not a responsibility to be exercised by the elected mayor. In fact, the memorandum by the DCLG and the Home Office specifically rules out the integration of health and social care as a mayoral function. I would be grateful if the Minister would confirm that there is no intention in future to make that a mayoral function.
The devolution of health and social care in Greater Manchester has arguably provoked the most interest among the public, stakeholders, politicians and, of course, healthcare professionals amongst others. From a position of, in principle, supporting devolution, I believe it is important to clarify some of the points about the way that this proposal will unfold over the coming weeks and months.
The legislation we are debating makes not a single reference to health and social care. That is reinforced by the fact that in the Explanatory Notes, under “Legal background”, no reference is made to any health legislation, particularly the Health and Social Care Act 2012. We know that the original Greater Manchester devolution agreement did not cover health and social care and that a very belated memorandum of understanding was agreed between the Government and the Greater Manchester Combined Authority to set in train the process of devolution of health and social care. Therefore, probing amendments have been tabled under Clause 6, “Other public authority functions”, to elicit further information in this area.
First, we seek clarification: does the Bill apply in any way to public authorities other than district, unitary and county councils? Specifically, do any NHS organisations—clinical commissioning groups, NHS trusts, foundation trusts or arm’s-length bodies, to name but a few—fall within the powers that Clause 6 gives to the Secretary of State for Communities and Local Government to transfer functions and property or rights to a combined authority? I anticipate that the answer to this is no, but that means that the Bill has no bearing on the health devolution proposals and its provisions cannot be used to enact health devolution. As I noted earlier, the Explanatory Notes do not include the Health and Social Care Act 2012, which also suggests that it has no competence in this area. I would therefore be grateful if the Minister could confirm the Government’s interpretation is the same as mine.
Secondly, having read the health devolution memorandum of understanding, I suggest that implementing many of its provisions may require, sooner or later, primary or secondary legislation. This could be desirable, not only to set out clearly the statutory basis on which responsibilities may move between existing bodies—for example, CCGs, local authorities, foundation trusts and so on—but also to frame accountability relationships. Where such arrangements are currently set out in the Health and Social Care Act 2012, it would seem that amendments to that Act, whether made using the powers of this Bill or made directly through further legislation, would be required. For example, if the Greater Manchester Strategic Health and Social Care Partnership Board required statutory powers—and many commentators are of the view that, for such bodies to really shape the services locally, they will require such powers, and this view has often been argued in relationship to health and well-being boards being the strategic body at a local level without any statutory powers—clearly, amendments to primary legislation will be required. I would be grateful if the Minister would confirm the position. We do not want to leave NHS organisations and their boards, which implement policies, open to legal challenge that they are acting outside or in conflict with legislation.
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Further on the subject of strategic boards, would the Minister support the view that its membership should include representatives of the criminal justice system, such as police, probation and voluntary organisations, which have a key role in shaping the health needs of local communities?
On a related matter, would the Minister also confirm that the commissioning of specialist services will remain the ultimate responsibility of the national Commissioning Board of the National Health Service? For example, again with reference to Greater Manchester, specialist cancer services delivered at hospitals such as the world-renowned Christie Hospital receive patients regionally, nationally and internationally. So they are not limited to people in Greater Manchester. We must avoid fragmentation and incoherence between Greater Manchester and the rest of the country in respect of specialist services. A view from the Minister on that important point would be welcome.
Further and crucially, without any changes to primary legislation, would the Minister confirm that the Secretary of State for Health still remains ultimately responsible to the public and Parliament for the health and social care services across Greater Manchester, or any other area that follows the path that Greater Manchester is taking on health and social care?
It would be remiss in this short debate on these probing amendments, particularly Amendment 36D, which exactly repeats the wording of the memorandum of understanding, not to mention funding. Paragraph 11.4 of the MoU, headed “Resources”, states that,
“it is recognised that the identified key workstreams will also require additional funding to support the transformation process. A programme and resourcing plan will be agreed with all parties by 13th March 2015”.
Has that plan been completed and, if so, how much additional funding has been made available to Greater Manchester either through the Better Care Fund, pump-priming money as suggested in the NHS five-year forward plan or, crucially, additional resources directed to the local authorities for social care, which have been decimated by cuts in the 10 districts of Greater Manchester over the past five years? If it has been completed, will it be published to enable public scrutiny of its plans so that there is confidence by the public in what is being proposed?
Finally, to ensure full scrutiny and accountability for the health and social care devolution, would the Minister agree that there must be robust governance structures in place in Greater Manchester—or any other similar area—to ensure full public scrutiny and accountability, particularly of the decisions of the Greater Manchester partnership board? Will the Minister confirm that all recommendations and decisions of the partnership board will be reported to the combined authority and be open to public scrutiny and accountability, and that the oversight and scrutiny committee of the combined authority will also have a robust role in such scrutiny?
Further, a report should be presented to Parliament, as we have suggested in Amendment 36E, so that the rollout of the devolution of health and social care is in place to enable Parliament to properly monitor the outcomes in terms of, among other things, the quality and standards of the delivery of a comprehensive and integrated health service by the combined authority. Our Amendment 36D makes it clear that any transfer of health and social care functions must abide by the four principles laid out in the memorandum of understanding and repeated in the amendment.
Lastly, I would be grateful if the Minister would confirm that there is no intention to vary the principles outlined in the memorandum as the devolution of health and social care unfolds. I beg to move.