My Lords, this is another really important group of amendments to do with the extent of devolution: what are the limits that the Government are putting on that? The only areas we have explored, very important though they are, are the National Health Service, policing, transport services—buses, in particular—and general functions. I have great sympathy with all the amendments in this group, particularly those introduced by the noble Lord, Lord Hunt of Kings Heath, asking where the National Health Service fits in with the notion of devolution to local areas.
As the noble Lord explored, currently the NHS does not fit in. A move was made in the Greater Manchester Combined Authority for the mayor to take the provision of health and care services—which we have not referred to so far—under his powers. That was accepted but has not made much progress. One of the biggest challenges, as has been said time and again in this Chamber in debates relating to other Bills, is the absolute importance of connecting the National Health Service and the social care system. Enabling devolution of NHS services to a mayoral combined authority would enable social care and NHS services to be properly linked. The result of no progress being made in this area is before our eyes; we have too many older people staying in hospital for too long, which harms their health, and they are not discharged into the social care service because the two are not linked. The Government have failed to do this time and again. Well, okay, devolve it—pass it on to local mayoral authorities so that we can see what progress they can
make. I repeat every sympathy, and support what has been said. I do hope it will be pursued at later stages of consideration of this Bill because it is so important for the health and well-being of the people we serve.
I will also wholeheartedly support the Clauses 58 and 59 stand part notices, for the reasons that have been said. I will give the example of West Yorkshire, where it was determined that the police and crime commissioner role would be combined with that of our elected mayor. Now we no longer have an elected police and crime commissioner because that role is unelected; they are appointed by the West Yorkshire mayor. That was her right; I am not saying she has done anything wrong. But who is now called to account for failings in policing in West Yorkshire? There have been a number of examples across the country where police and crime commissioners have, for various reasons, been found wanting and have been held accountable for their actions. How does that work in a combined mayoral authority where the mayor appoints the police and crime commissioner? Does the mayor have to be held accountable for the decisions and actions of their appointed deputy? That is the only way that accountability can take place. The attempt by the Government to undermine an elected process is undemocratic. How do the Government think that local people will feel about the very important role of holding policing in the West Midlands to account when an elected police and crime commissioner there is somehow unelected? Those two big issues are very important. It is about whether we are talking about devolution to local areas or still talking about centralised systems where there is delegation to combined authorities—which leads nicely to buses.
I cannot add to my noble friend Lady Randerson’s description of what has happened to the bus services and how important they are to any hope of levelling up for many parts of the country. As she said, if you cannot get a bus in order to access employment then, for many people, it is financially impossible to do other than stay at home. Mayoral authorities need to be given the powers to control bus services, as bus services should be encompassed in mayoral authorities. In giving another local example, I should point out that it was done before the mayoral authority was set up. Nevertheless, it comes from the centre of West Yorkshire where, in my own area, we have a number of small villages where the bus services were poor and people could not get about. Fortunately, there was not only one bus a week—like the noble Baroness, Lady Hayman of Ullock, has, I think—but services were poor throughout the day. We managed to get a subsidy for what I call a small hopper bus—a 15-seater—to go around the various parts of the Spen Valley area and pick up older people, take them into town to do their shopping, collect them and go back again. After a bit, because it was so popular, it has become a self-financing bus service. With local initiatives comes success because local areas know what would probably work for their patches. That is why enabling mayoral combined authorities to have control over bus services is so vital.
Any notion of levelling up will not work without the aspect of transport. There has been too much focus on rail services, which are very important but do
not feature in a lot of people’s options for transport. I repeat that my noble friend Lady Randerson made a powerful case for ensuring that mayoral combined authorities can run bus services. Without that, many people—especially in rural areas, but not only in rural areas—will find that they cannot access the services and jobs they need to if levelling up is to be anything other than a slogan.