Clause 79
Local Government and Public Involvement in Health Bill
2:43 pm
Tom Brake (Shadow Minister, Department for Communities and Local Government; Carshalton and Wallington, Liberal Democrat)
It is a pleasure to see you in the Chair, Mr. Benton. We now come to the meat of part 5, which will allow local councils to deliver the strong and prosperous communities that the Government, the official Opposition and my party want to see. Local area agreements and the extent to which they can bind in and integrate the activities of partners will ensure delivery. We support fully the concept of local area agreements and allowing local authorities working with their partners to set priorities for an area.
I shall not, however, use the phrase “place shape”. It is something that I cannot stomach; it is far too new Labour for me. It is also a phrase that the public may not necessarily understand. Setting priorities is what the provision and local area agreements are about. That will be achieved by local improvement targets which, for the purposes of this afternoon, I shall abbreviate to LIT—not to be confused with local income tax, a very good alternative to the council tax system. However, although I might be tempted to engage the Government in a long debate about that alternative form of paying for local services, I understand that here is neither the time nor the place to do so.
The purpose of local improvement targets under the Bill is to improve economic, social or environmental well-being in a particular area. That will be achievable only when local authorities can undertake that role effectively, working with relevant partners. That is where the Bill is defective. It is appropriate to highlight some of the partners who will be missing from the table, unless the Government change the Bill.
That brings me to amendment No. 49 and NHS or foundation trusts. I accept the arguments put forward by the NHS Confederation that primary care trusts commission health services from NHS acute or foundation trusts, and that it will be the body that will hold those trusts to account for the services that they deliver. I disagree with the confederation’s view that, by including NHS or foundation trusts as a partner, it will create partnerships with no purpose. The confederation says that the key is to get the right people in the room.
There will be occasions when those from NHS and foundation trusts are the right people to get in the room. I am sorry to say that often the NHS partners are the most reluctant to get into the room. In the past few months, I have been conducting research among local authorities and know that one of the impacts of the financial pressures on NHS trusts means that they are scaling back their involvement and partnerships. They are not putting in the resources or the time to get people round the table, so it is a serious omission that NHS and foundation trusts are not included in the Bill.
Clearly, the PCTs can use their contracts and will do so to ensure that the NHS and foundation trusts deliver in respect of health, but what about other matters in which the local authority might want to engage a local NHS trust—a large employer and generator of traffic—as a partner around the table? Let us consider traffic congestion. St. Helier hospital in my constituency is a large employer; it generates lots of vehicle movement. The local authority has an interesting scheme under way at present to reduce people’s use of private cars and make them aware of public transport alternatives. To what extent will a primary care trust be able to negotiate with an acute trust about engaging it in the process of reducing traffic congestion in and around the borough? The answer is not at all.
All members of the Committee can think of other cases—whether skills or employment—when we might want to involve partners directly and for them to include NHS and foundation trusts. I shall listen with great interest to the reasons why such a provision has been omitted from the list, but it will require a convincing explanation for us not to pursue the matter if not today through a Division, but at a later stage.
Amendment No. 88, tabled by the official Opposition, is in the same ballpark in what it seeks to achieve—more effective engagement with NHS partners than currently exists. Amendment No. 65 touches on the NHS, but it also includes the Mayor and Transport for London.
On amendment No. 117, I am sure that the Minister agrees with the LGA that the success of local area agreements, as well as depending on partners such as the NHS whose engagement we want, depends on central Government’s willingness to play a full role. Surely central Government’s role should not be simply to approve LAAs, but to engage heavily in the process and to show that they are a willing partner. For instance, if a local improvement target will address social disorder and antisocial behaviour in an area, there are clearly circumstances in which the local authority will want the Home Office to be engaged in the process. A local authority seeking with its partners to introduce targets on climate change, particularly a local authority in a coastal area, will want to engage the Department for Environment, Food and Rural Affairs in the process. For that reason, we have suggested in amendment No. 117 additional partners whom we believe should be around the table to discuss local area agreements and targets with local authorities and other partners.