New Clause 20
Local Government and Public Involvement in Health Bill
2:00 pm

Phil Woolas (Minister of State (Local Government & Community Cohesion), Department for Communities and Local Government; Oldham East and Saddleworth, Labour)

I beg to move, That the clause be read a Second time.

Joe Benton (Bootle, Labour)

With this it will be convenient to discuss Government amendment No. 245.

Phil Woolas (Minister of State (Local Government & Community Cohesion), Department for Communities and Local Government; Oldham East and Saddleworth, Labour)

New clause 20 and Government amendment No. 245 relate to the desirable objective of bringing local authority services and health services closer together. It is proposed to establish a joint needs assessment to ensure that social care services and health services jointly engage in the assessment of local health needs. The argument behind the proposal is that we must do that without imposing extra or excessive bureaucracy in the system.

The types of needs assessment that already take place in some areas consider medium and long-term health needs. One area may have a particular difficulty with heart disease, lung disease or some such, and other areas may have different needs. The new clause allows for local discretion, but, in so far as it is not devolutionary, it compels health authorities and local authorities to do the needs assessment together. It will strengthen earlier clauses on local area agreements by requiring the responsible local authority and the primary care trust, being the two lead bodies, to produce such a needs assessment.

To put it on the record, a “need” means a significant overlap in the impact or potential impact of the exercise of functions of the primary care trust and the responsible local authority. Such an area might include social care provision for older people, which will be substantially affected by the delivery of both preventive and acute health care primarily by PCTs.

Michael Fabricant (Whip, Whips; Lichfield, Conservative)

Would not that always occur? Is there not always a problem when, for example, a cottage hospital is unable to discharge an  elderly person because there is no available place for them in a nursing or care home? I welcome what the Minister is saying, but he uses the word “if”. I would say that it is virtually probable in every district that that very problem will occur, particularly with an elderly population.

Phil Woolas (Minister of State (Local Government & Community Cohesion), Department for Communities and Local Government; Oldham East and Saddleworth, Labour)

The hon. Gentleman makes a fair point. We are talking about the assessment of needs. It is a future assessment, and in that sense, it is not directly about the delivery of services. We are trying to address the fact that in some parts of the country, the PCT undertakes a needs assessment as part of its duties while a local authority addresses its social care priorities. The new clause is about joining up, simplifying, getting rid of bureaucracy and all the things behind the thrust of the Bill.

Hon. Members might recall mention during debate in Committee of there being too many targets. It is quite possible to have one target for a local authority and another, sometimes contradictory, target for health care. The deputy group leader of the Local Government Association’s Conservative group, Councillor Milton from Westminster, often cites the case of Kent, which discovered apparently contradictory targets on teenage pregnancy for the local authority and PCT. That is not desirable. Members know of examples in their constituencies; indeed, we get applause during after-dinner speeches for pointing out contradictions in the bureaucracy. The new clause will address that problem. The hon. Member for Lichfield has a fair point, but the measure deals with needs assessment.

The hon. Gentleman mentioned districts. I believe that he represents an area covered by a district, one that we have heard about during this debate—Lichfield. We should not forget south-east Staffordshire and Staffordshire as well. The new clause will address that issue by requiring that in two-tier local authority areas, the county council must consult its district councils on the joint needs assessment.

Supporting statutory guidance on the clauses and part 5 of the Bill will make it clear that the local authority should take into account the joint strategic needs assessment’s findings in setting targets in the local area agreement and in preparing the sustainable communities strategy, a point that I also direct to members of the Committee considering the Sustainable Communities Bill. I put it on the record because it will be useful to me in that Committee on Wednesday. The new clause should be seen as part of the broader provisions in part 5 to strengthen partnership. That in turn, we hope and intend, will help to deliver more responsive care.

Government amendment No. 245 will amend the Bill to ensure that new clause 20 comes into force by means of a commencement order rather than automatically two months after Royal Assent. That is a practical step to ensure that PCTs and local authorities have been provided with the necessary guidance to assist them in meeting the duty.

Tom Brake (Shadow Minister, Department for Communities and Local Government; Carshalton and Wallington, Liberal Democrat)

Given that the new clause refers to the responsible local authority, might there be circumstances in which a  number of local authorities need to get together to do a health and social care assessment? Will the new clause provide for that?

Phil Woolas (Minister of State (Local Government & Community Cohesion), Department for Communities and Local Government; Oldham East and Saddleworth, Labour)

The hon. Gentleman makes an important point. It will. It puts the responsibility on the responsible local authority, which means the local authority responsible for social services. In that case, the local authority with more than one PCT would be covered. The responsibility is on the local authority as well as the PCT.

We are not so much banging heads together as saying, “Make arrangements so that the needs assessment for your area is covered.” The needs assessment itself would be for the local authority area and not necessarily the PCT area, which may be different in those instances where there is no coterminosity, which as the hon. Gentleman knows, are fewer now than they used to be due to the joined-up nature of this Government. I hope that, rather like the provision on joint waste authorities, that is seen as sensible.

We backed away—just to share this information with the Committee—from the requirement to put this assessment in the community strategy. That would be unpicking strategies that had already been decided. I expect that they will be part of that joint strategy. However, we do not want to make it a tick-box exercise, to use the management jargon; we want to make it real. On that basis, I commend the new clause to the Committee.

Bob Neill (Bromley and Chislehurst, Conservative)

I have one brief point to make. I very much welcome the thrust of this new clause together with the other parts that strengthen consultation. I hope that this will enable us—I am sure that the Minister will be able to confirm it—to look not only at needs of the type that he referred to in his own comments but, for example, at the increasing need for capacity in GP surgeries and to make sure that there is clear involvement of the local authority.

If that happens, I hope that we can avoid the thoroughly unsatisfactory situation which arose, only this week, in my constituency. Due to a lack of capacity, a GP surgery suddenly got the PCT to issue a direction to change its catchment area. About 1,200 people, some of whom are quite elderly and have been with that surgery for 50 years, are arbitrarily told that they have to find another doctor. This is the excellent Bromley Common practice. The PCT arbitrarily took that decision because of a capacity issue. Neither the local council nor the local Members of Parliament knew anything about it until constituents and the local newspapers got on to them. This measure is welcome if, together with the other provisions that we have already discussed, it goes some way to preventing that thoroughly unsatisfactory situation.

It is important that the ethos of early consultation and involvement of elected representatives and patients is built into the system right the way through. I expressed concerns about the abolition of the patients forums and how effective LINKs would be in this regard. This is a classic example. This surgery’s problem arose due to the Mayor of London, about two  years ago, directing refusal of an application to build a surgery because the land was green belt. There has been a crying need for an alternative proposal for that practice, but there has not been a mechanism to pull everything together. In the end, we get this arbitrary decision without any form of consultation, which has caused great distress to a lot of my constituents. I hope that this provision will provide some means of dealing with such issues and would like reassurance on that point.

May I tell the Minister while he is thinking about it—to give him a little more time—that the Minister for London very much appreciated his Alan Curbishley joke?

Phil Woolas (Minister of State (Local Government & Community Cohesion), Department for Communities and Local Government; Oldham East and Saddleworth, Labour)

I think that my Parliamentary Private Secretary appreciated it even less. That is probably why she is not here.

The reason for my puzzlement is that I do not honestly think that this clause addresses the hon. Gentleman’s point. I think that the rest of the Bill makes the situation that he describes less likely. This provision is not about the delivery of services. It is about the initial planning phase of a joint assessment of the health needs of the area. The GP capacity is directly and primarily a matter for the PCT. The hon. Gentleman will know that GPs stand in an unusual relationship with PCTs. The joint needs assessment could examine GP capacity as a need of course, but the PCT must take action to increase or decrease that capacity. That relates to our debate about the planning of services and the consultation on that issue. I hesitate to give the hon. Gentleman a guarantee, because the real world will get in the way of any such Government guarantee, particularly if a GP retires or other policies intervene.

Bob Neill (Bromley and Chislehurst, Conservative)

I feel slightly guilty about putting the Minister on the spot, but this has been a timely opportunity to put that particular concern of my constituents on the record. Will he take that concern—particularly the points about consultation and planning—back to his colleagues in the Department of Health?

Phil Woolas (Minister of State (Local Government & Community Cohesion), Department for Communities and Local Government; Oldham East and Saddleworth, Labour)

I am more than happy to endorse the press release to the local paper in south-east London. The serious point is that the value of scrutiny has been demonstrated, and whatever policies one puts in place, they will never be perfect. That raises the paradox of devolution and equity. We have devolved power to a London level, but if London disagrees with the decision of a different level, one has problems. However, returning to the narrow confines of the Government new clause, in deference to my boss, the Whip, I shall sit down.