National Health Service Reform and Health Care Professions Bill
Earl Howe (Conservative)
My Lords, in moving this amendment, I shall speak also to Amendments Nos. 17, 18, 22 and 24. We debated these amendments on Report. They propose a duty of scrutiny for local authorities in substitution for the power of scrutiny conferred on them by the Health and Social Care Act 2001. This is an important issue. When confronted by a matter brought to their notice by a patients forum, my concern is that some local authorities may simply choose to ignore it and do nothing; either because they have other priorities, or because they do not have the necessary resources.
As matters stand, there is nothing in this Bill or elsewhere to ensure that patients forums will be listened to; yet scrutiny of health issues by local authorities is absolutely central to patient and public representation. It is a function currently carried out by CHCs. If nobody has a statutory duty to scrutinise health issues, and, where necessary, take action, patients forums will simply be left talking to a brick wall. In fact, except in the context of minor matters that can be sorted out within the narrow confines of a trust, forums will almost cease to have a point.
On Report, the noble Lord, Lord Filkin, argued that under the Local Government Act 2000 local authorities already have a "responsibility"—I use his word—to promote the economic, social and environmental well-being of their areas. He added:
"It could not be clearer that they are responsible for promoting the health and well-being of their communities".—[Official Report, 30/4/02; col. 619.]
On those grounds the noble Lord considered my amendment unnecessary.
As the noble Lord is aware, I took his statement to mean, first, that local authorities already have a duty to promote the health and well-being of their communities; and, secondly, that the provisions of the Local Government Act are directly relevant to the scrutiny of health issues. I withdrew my amendment on that basis.
Following the debate, the noble Lord was kind enough to write to me to correct my interpretation of his words. He said that when he had spoken of local authorities having a responsibility to promote the economic, social and environmental well-being of their areas, I should have understood him to mean that they had a power to do so. I do not think that I can be blamed completely for having interpreted the noble Lord's words as I did. However, that was a helpful clarification and I am grateful to him.
The other part of the noble Lord's argument was also important. I have had an opportunity to examine the Local Government Act 2000. Section 2 contains the power that I have just mentioned, and Section 4 contains a duty for a local authority to prepare a strategy for promoting or improving the economic, social and environmental well-being of their area and contributing to the achievement of sustainable development in the United Kingdom. Perhaps two questions arise from that. First, given that health is not specifically mentioned in the Local Government Act at that point, can the Minister confirm that Ministers and the Department of Health have received legal advice that,
"economic, social and environmental well-being"
in the Local Government Act subsumes health?
Secondly, can he confirm that the power contained in Section 2 of the Local Government Act should be interpreted as implying a power of scrutiny of health issues? If the answer to both those questions is yes, I would find that encouraging. If it is yes, can the Minister say whether the Government are prepared to issue guidance to local authorities to make that matter clear, and whether they could incorporate guidance about the content of the strategy mentioned in Section 4 of the Local Government Act to the effect that the strategy should cover health issues as well as all the rest?
What the Minister was essentially saying on Report was that my amendments were unnecessary for the reasons I have given. He was also arguing that the amendments, in so far as they created a duty, were undesirable, on the grounds that it is wrong, as he saw it, to impose duties on democratically elected bodies such as local authorities. I have reflected on that argument. I am not sure what I think of it, really. It was clearly Parliament's intention when it passed the Health and Social Care Act 2001 that local authority overview and scrutiny committees should have the function of scrutinising matters relating to health. In other words, it was not in Parliament's mind that local authorities should pay lip service to the function or that they should fail to perform it at all if they did not feel like it. The whole point of setting up overview and scrutiny committees was to ensure that the scrutiny function currently performed by CHCs should be safeguarded.
I believe that we should ensure that the edifice of patient and public involvement really does stand up, which is why I am proposing this amendment. In other spheres, the Government have not been averse to imposing duties on local government—witness for a start Section 4 of the Local Government Act. In a matter as important as this, I really see no reason why there should not be such a duty in order to ensure that what the Government themselves say they want really does happen. I beg to move.