Clause 178
Health and Social Care Bill
3:30 pm
Emily Thornberry (Islington South and Finsbury, Labour)
I beg to move amendment 368, in clause 178, page 151, line 14, leave out ‘a representative’ and insert ‘representatives’.
Mike Hancock (Portsmouth South, Liberal Democrat)
With this it will be convenient to discuss the following:
Amendment 369, in clause 178, page 151, line 16, at end insert—
Amendment 361, in clause 178, page 151, line 18, at end insert—
Amendment 370, in clause 178, page 151, line 28, after ‘appoint’, insert ‘more than’.
Amendment 371, in clause 178, page 151, line 31, leave out subsection (7).
Emily Thornberry (Islington South and Finsbury, Labour)
Before the Minister tells me that we are being over-prescriptive, may I ask him why it is that when the Bill establishes all kinds of boards and organisations there is no spelling out, but when it comes to local government—when it comes to the heart of the measure and to everybody allegedly being brought together—the Government are being as prescriptive as they are? In giving us this great long list of all the people who should be on the health and well-being board, they should at least get it right. That is why we have tabled the amendments.
For example, the Government prescribe that the health and well-being board should have “a representative” of the local healthwatch organisation for the area of the local authority. Why only one? Why should we not have “representatives”, which is what we propose in amendment 368? Amendment 369 raises the question why, if we have a representative of each relevant commissioning consortium, should we not also have a representative of people involved in housing and a representative of the police? In modern life, the police probably have a great deal to do with people with mental health issues, as well as expertise in the local area.
Government Members appear to be having very different reactions to that point, but the reality is that many anti-social behaviour problems arise because people have mental health problems and cannot relate properly to their neighbours. In the end, there is a problem of how to deal with such people. Their condition may not be sufficiently acute for an emergency team to be brought in, but if their neighbours find such behaviour difficult, they might involve the police. In some areas, therefore, the police have a better understanding of the mapping out of acute mental health problems, so it would be of value to have the police’s wisdom and advice on the health and well-being board.
Dan Byles (North Warwickshire, Conservative)
I make this point in a genuine attempt to help the hon. Lady. I sat on the board of a mental health trust and several of its committees and sub-committees, and although we often liaised with the ambulance service and the police, we found that it was incredibly difficult to get the police to be regular attendees at committees or sub-committees because they were so busy. They preferred to be invited when specific issues were to be discussed, rather than to be standing members. They were very resistant to being standing members on any of our committees or sub-committees.
Emily Thornberry (Islington South and Finsbury, Labour)
I am grateful to the hon. Gentleman for giving us that interesting information.
We argue that other people ought to be considered, as well. Representatives of district councils are also experts in their area, and should be included.
Nick de Bois (Enfield North, Conservative)
I sense that Opposition Members regularly feel the need to prescribe for just about every option. It strikes me that clause 178(8) leaves health and well-being boards discretion in whom to invite—basically, they can invite pretty much anyone to come in. We must assume that people will act in the best interests of their residents and take advantage of that provision, if the circumstances arise.
Emily Thornberry (Islington South and Finsbury, Labour)
Clause 178(8) is not a stand-alone clause stating:
“The Health and Wellbeing Board may appoint such additional persons to be members of the Board as it thinks appropriate.”
The clause also contains a detailed prescriptive list, so I am asking why the Government include some people but not others. In this Committee, it is important that we prise from the Government why they have chosen certain bodies and not others.
Amendment 370 relates to subsection (5), which states
“Local Healthwatch Organisation for the area of the local authority must appoint one person to represent it on the Health and Wellbeing Board.”
Again, why does the local healthwatch organisation have only one representative, given that we have heard from the Minister how important that body is? If the Government prescribe that there is only one representative, will health and well-being boards not feel unable to appoint more than one? If there can be more than one, why does the provision state “one”?
The most important and telling provision in the clause is subsection (7), which strikes me as extraordinary. It states:
“A person may, with the agreement of the Health and Wellbeing Board, represent more than one commissioning consortium on the Board.”
According to the explanatory notes, it seems that the provision is made out of consideration for doctors or those from commissioning consortia who may be terribly busy and have more important things to do than to appear on health and well-being boards. In a local authority area with two or three commissioning consortia, the Bill, if unamended, will allow one representative of all the commissioning consortia to join the health and well-being board—because that is more efficient, perhaps. An alternative explanation is that health and well-being boards are only a cover, and will not have the sort of power that the Minister claims they will. Although the boards are supposed to be accountable, they may actually be powerless, and perhaps we do not want such bodies to impinge too much on the time of doctors, who are not powerless. Doctors will spend the money, so perhaps we do not need them to waste a great deal of time going along to troublesome things such as health and well-being boards. If I am not right, we should take out subsection (7).
Paul Burstow (Minister of State (Care Services), Health; Sutton and Cheam, Liberal Democrat)
The hon. Lady is right to say that she is not right. She is also right to say that there is no reason to accept the amendments. They are unnecessary. Had we done the exact opposite of what we have done in the Bill, I suspect that the hon. Lady would have argued that it was appalling that GP commissioning consortia would not have the flexibility and the opportunity to delegate—
Paul Burstow (Minister of State (Care Services), Health; Sutton and Cheam, Liberal Democrat)
Let me deal with some of the hon. Lady’s other points first.
Let me reiterate a point that is key to understanding this part of the Bill. It sets out the de minimis membership. It should not be seen by anyone who reads it, after the Bill is enacted, as providing a mandate, saying “These are the only people who can serve on this board” and no one else could possibly sit on it. What is absolutely clear from the White Paper consultation and discussions that we continue to have with colleagues in local government is that the flexibility that the Bill provides in relation to the arrangements for health and well-being boards is widely welcomed. Manchester city council and the Manchester adults health and well-being partnership have welcomed the
“local freedom to determine the most appropriate membership reflecting the national statutory framework”
that the Bill establishes. Norfolk county council say it supports our approach
“which sees only a limited number of partners subject to a ‘duty to cooperate’ leaving top-tier authorities with the freedom and flexibility to decide any wider representation”.
The amendments detail bodies or organisations that it would be entirely appropriate to have on a health and well-being board, such as the police. Although my hon. Friend the Member for North Warwickshire has given reasons why that may not always be appropriate, the police certainly could be included. Government Members are not concerned about having an incomplete list, but about having one that can be interpreted not as a minimalist list, but one that excludes others and prevents them from being added to the board. That is why we have crafted the Bill as we have. It is about how best to ensure the maximum local flexibility and that the arrangements work well when it comes to the relationship between health and well-being boards and GP consortia.
Debbie Abrahams (Oldham East and Saddleworth, Labour)
Perhaps the Minister is not aware that a consequence of that minimalist approach is that some local authorities are deciding to designate their directors of public health at third tier level. In spite of what was advocated in the public health White Paper, which said that directors should be directly accountable to the chief executive, they are going to be at assistant director level—not directly accountable, therefore. Their budgets will be under the responsibility, perhaps, of directors of adults’ services, or children’s services. Those are the unintended consequences, and we are trying to show what needs to be firmed up in the Bill. Such points are very important.
Paul Burstow (Minister of State (Care Services), Health; Sutton and Cheam, Liberal Democrat)
They are points; they are important; but they are not points that relate to this set of amendments. The clause is about who sits on health and well-being boards and about who discharges the various functions that sit with such boards. We make it clear, as a de minimis requirement—not a minimalist requirement—that the director of public health should sit on the health and well-being board. What we are not trying to do, and the reason why we are resisting the Opposition amendments, is to construct an ever-lengthening list that increasingly excludes anyone who is not on it. That is why we are not having such a list.
Debbie Abrahams (Oldham East and Saddleworth, Labour)
I was just using that as an example. The Minister referred to a minimalist approach, and I gave an example of what happens when such an approach is used. Unfortunately, there will be unintended consequences that are directly counter to what the Government are trying to achieve. We all share the ambition to improve health and the quality of health services, and to reduce inequalities, but unfortunately, if the Government use a minimalist approach—I use that term again—that is what will happen. They will not achieve what they say they are seeking to achieve.
Paul Burstow (Minister of State (Care Services), Health; Sutton and Cheam, Liberal Democrat)
I reiterate that our position on the membership of health and well-being boards is not minimalist but de minimis. To make things absolutely clear to those who read our proceedings in future to interpret what we intended for the membership of the board, this is not about limiting the board’s ability to decide who else should be a member or limiting the local authority’s ability, when establishing the health and well-being boards, to think carefully about who should be involved. Interestingly, the early implementers of health and well-being boards are already exploring a variety of options. That is good and creative, and we should allow such practice rather than stifling it by imposing a long list.
Daniel Poulter (Central Suffolk and North Ipswich, Conservative)
Is that not exactly the point? The local needs in Eastbourne, for example, which involve looking after older people, are completely different from those in the constituency of the hon. Member for Easington, who is concerned about housing and the quality of housing stock. That is why we need flexibility in the arrangements, rather than being too prescriptive.
Paul Burstow (Minister of State (Care Services), Health; Sutton and Cheam, Liberal Democrat)
The hon. Gentleman is absolutely spot on, and he underlines the difference between the two sides of the Committee. I hope, none the less, that the purpose of this set of exchanges was to probe and to seek clarification and reassurance that although the Bill says that one healthwatch member should be on the board, that is a de minimis requirement and does not preclude the possibility of more. I hope that the hon. Member for Islington South and Finsbury will withdraw the amendment. If she does not, we will resist it.
Emily Thornberry (Islington South and Finsbury, Labour)
That was exactly the purpose, and I beg to ask leave to withdraw the amendment.