Local Government and Public Involvement in Health Bill

– in the House of Lords at 3:31 pm on 20th June 2007.

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Photo of Baroness Morgan of Drefelin Baroness Morgan of Drefelin Government Whip 3:31 pm, 20th June 2007

My Lords, I beg to move that this Bill be now read a second time.

Noble Lords who were involved in the Greater London Authority Bill late last night will be well aware of the valiant efforts made by my noble friend Lady Andrews to speak through a very difficult cough—which I am afraid has made it impossible for her to address the House today. However, we are very much looking forward to her joining us for the remainder of her Bill. I am looking forward alsoto the two maiden speeches which we will hear later from the noble Baroness, Lady Campbell of Surbiton, and the noble Lord, Lord Mawson.

The Bill is about greater devolution of power to local government and greater local democracy. As such, it reflects a vibrant public debate which has called for a shift in power away from central government and towards local government and the citizen. The Bill is therefore perhaps more radical in the changes it will bring than it may seem—changes not only in the organisation of local government and the work of councils and councillors but in the culture of partnership and the shaping of local services. It is driven essentially by the aspirations and experience of local government itself.

The Bill is essentially pragmatic. It is driven by what changes have worked well and by a two-year conversation with local authorities and partners across England which culminated in the White Paper. The Government have continued to listen intently and that is reflected in the many changes made in the other place which have strengthened local control in different ways. In that respect this Bill is significantly different from every other local government Bill that has come before this House.

Quite simply, we seek to build on success. I begin by celebrating the great improvements that have been made in the quality of our local public services over the past decade. Homelessness is at its lowest since the early 1980s and housing supply has increased by over one-third. Nearly 80 per cent of authorities are now rated good or excellent. We have increased funding by 39 per cent in real terms since 1997, and every local government in England now has a local area agreement providing increased flexibility for local government and partners. These improvements have been achieved by local government but they have been largely and deliberately driven from the centre. Now we need to change our approach and give local authorities and partners the freedom and space that they need to shape and make places for the future. That is increasingly seen as the defining role of local government and it is a role that needs to be strengthened. The Bill will make local authorities more powerful and more visible.

Part of the challenge for local government now is to work more strategically and particularly to work closely with health partners to take greater shared responsibility for delivering more coherent services. That is why, throughout the Bill, we address how health fits into the picture. Crucially, we are giving a stronger voice to local people, whether in the ability to create new parish councils, to seek greater help from councillors or to have new rights to be informed, consulted and involved.

I will outline the key themes of the Bill; five key elements will strengthen local government. These are set out variously in Parts 1, 3, 4 and 5. First, authorities in two-tier areas will be enabled to propose a move to simpler structures. This will be matched by promoting better partnership working in the remaining two-tier authorities. Secondly, we shall build on successful models of strong local leadership. Thirdly, we shall remove the power of the Secretary of State for traditional and specific responsibilities, for example in relation to the creation of parishes. Fourthly, we shall create a better, more proportionate way of ensuring and measuring local improvement. Fifthly, we shall create a transparent way of agreeing between central government and local government and its partners a small number of core priorities specific to each locality which cover the social, economic and environmental needs of local areas.

One of the most profound challenges we face is to create greater knowledge and confidence in local government, not least so that improvement is recognised and to make the work of local government immediate and relevant to people. There is no doubt that however effective it may be, the complications of a two-tier system of local government makes this much more difficult.

Eighteen months ago, therefore, we invited councils to tell us what was working and what was not, and what they wanted to improve and change. In a number of areas there is determination to make the two tiers work better. However, in some areas there is a strong feeling that the current system cannot be made to work and that the unitary option makes more sense. We have responded to that. This Bill puts in place a procedure for voluntary structural change. This is not about change for change's sake; it is about improving accountability and leadership, increasing efficiency and achieving better and more responsive services for communities.

I shall explain the process and the timetable. The timetable is driven by a full recognition that proposals for restructuring can create uncertainty and tensions. That is why we are committed to progressing towards implementation as soon as possible. The invitations for proposals were issued last October. As a result we shall be able to move towards implementation quickly, with new unitary authorities up and running byMay 2009. We are consulting on 16 proposals for unitary structures. Each of these proposals was judged against strict criteria, including the need to show that there is a broad cross-section of support, affordability and value-for-money services. The Government's assessment was that there was at least a reasonable likelihood that those proposals, if implemented, would meet the criteria. The consultation closes on 22 June. Decisions will be made at the end of July.

I want to address a related point. In the other place there were concerns about the Secretary of State's power to direct councils to submit proposals for unitary structures set out in Clause 2. Working with the LGA, we have therefore made amendments in the other place so that now this power can be used only during a narrow window. In addition, my right honourable friend the Secretary of State indicated at Second Reading that we would use this power to deal only with residual areas in order to ensure that a proposal received in response to our invitation and which we are minded to implement, works properly for the whole area concerned. I am pleased to be able to reiterate this commitment publicly today.

Clearer local responsibilities need to be matched with clearer local leadership and clearer accountability. I am pleased that the noble Lord, Lord Heseltine, recognised the value of strong local leadership and direct elections in his interim report from the Cities Taskforce. Improving local areas has never been more difficult. It seems that we are in agreement that council leaders need the power to take tough decisions and to develop and communicate a clear vision for their area.

While the best leaders can be successful in any system, the evidence shows that executive governance arrangements are most likely to lead and support the strong and accountable leadership that places need. We are confident that the three executive models set out in the Bill will provide this leadership. The three models are an elected mayor, an elected executive and a leader and cabinet executive. The small number of authorities that because of their size have opted to operate alternative arrangements will continue to be able to do so if they choose. Where an authority has a leader and a cabinet executive, executive powers will be vested in the leader, who will be able either to exercise the powers himself or herself or delegate them. We will expect a council's constitution to continue to explain which functions are to be discharged by the executive. Overview and scrutiny committees will be able to investigate the way in which executive powers are used. Functions that legislation or a council's constitution require to be discharged by the full council will be unaffected and will continue to be discharged in the usual way.

We are greatly strengthening powers of scrutiny so that they extend beyond the council. For the first time, overview and scrutiny committees will have the power to require information from certain key local powers, which will already have an enhanced role in the making of community strategies and local area agreements. Those local partners will be required to have regard to the reports and recommendations that the committees produce.

The third area of change will increase the autonomy of local authorities, for example by transferring the responsibility for decisions on the electoral cycle of a local authority from the Secretary of State to local government. We are taking the Secretary of State out of the equation in relation to community governance and by-laws. We are increasing local ownership of conduct issues by devolving most decision-making on conduct to local authorities. Crucially, we are also devolving powers to the National Assembly for Wales to enable Wales to legislate for itself on a range of local government matters covered in the Bill.

The conversations that we have had with local government have made it clear to us that they and their partners spend too much time addressing the requirements of central government rather than those of citizens and communities. That is why we are seeking through the Bill to increase the ability of local authorities to determine and focus their own local priorities. The best value regime will be streamlined and will sit alongside a completely revised framework for monitoring and reporting on local authorities' performance. The number of national indicators will be reduced from 1,200 to a robust set of 200 indicators that will focus on outcomes and will make sense as local priorities. That will be complemented by a new comprehensive area assessment system that will focus less on upwards reporting and more on identifying risks to service delivery in an area and on citizens' experiences. Other changes will bring local authorities into a new and more effective connection with other local partners that are responsible for the well-being of the community. That partnership has already been enhanced by the local area agreements in every local authority, but the local area agreements have been too limited to reach their potential to become the delivery plan for the whole sustainable community strategy, which is the sum of the needs and aspirations of the whole community.

The Bill makes this possible by expanding and strengthening the role in two ways: first by placing them on a statutory basis and secondly by extending their coverage and partnership, so that they become the sole delivery agreement for the issues which local authorities wish to tackle on their own or in partnership with others; such as community safety, childhood obesity or economic inactivity.

I shall explain how this process will work in practice. Each responsible local authority, its partners and the relevant government office will identify the core challenges facing each local area. Against these priorities will be set around 35 local improvement targets, although in some areas there may be fewer. These will be designated targets and will be set against the 200 or so national indicators. But the local authority and its partners will also be free to set other local targets, should they wish to do so.

Most significantly, we are placing a statutory duty on key public agencies to co-operate. This will give local authorities the levers that they need to bring together all the key partners in an area to agree the core community priorities for action. These duties will not exclude other organisations from participating in the negotiations or even from signing up to local improvement targets on a voluntary basis. As a result, local people will have a clearer idea of the priorities of their local council, how their needs will be met and who will be responsible.

In another innovative step, we are requiring local authorities and primary care trusts to work together to produce a strategic assessment of the health and social care needs of their local population. This will also feed into the sustainable community strategy and, in turn, the priorities agreed in the local area agreement. We are also providing the opportunity for greater flexibility and efficiencies in the delivery of waste services—both collection and disposal—through powers to allow the voluntary establishment of the statutory joint waste authorities.

We want to improve the relationship between local government and the local community by amplifying the voice of the local community and giving more scope for local councillors to champion their interests. We are also placing a statutory duty on English best-value authorities to inform, consult or involve representatives of local people—for example, through newsletters, posters and neighbourhood forums. Of course, many best-value authorities already do a great deal to involve and consult citizens and communities, but we want to ensure that all people, irrespective of where they live, work or play, have opportunities for involvement. We are adopting a similar approach with regard to the health services by strengthening the existing requirements on NHS organisations to consult patients and the public in the planning and development of health services.

Local people will also have a louder voice in another way. We are introducing the Community Call for Action, through which a councillor will be able to refer an issue to an overview and scrutiny committee and require a response.

That brings me to the final element of the Bill that I want to discuss. The fact that it is at the end of the Bill and confined to a single part—Part 14—does not diminish its importance. We can see by the number of speakers who have an interest in health that this is held up in your Lordships' House as well.

For several years, we have been engaged in trying to ensure that patients and the wider public are properly involved in their local health services. Patients' forums, which we debated in this House in 2002, moved patient and public involvement on, raising its profile and producing many success stories. I pay tribute here and now to the hard work, expertise and enthusiasm of patients' forums throughout the country. As I shall make clear, we feel that it is essential that the energy and expertise of the forums, far from being lost, must be captured within the new local involvement networks. I shall explain the key features set out in A Stronger Local Voice, published in July 2006, which was based on a nine-month review of patient and public involvement.

The changes that we propose are, first, to make patient involvement genuinely local. It will no longer be confined, as patients' forums were, to single institutions such as acute hospitals or PCTs, but will cover all services provided across the whole local authority area. Secondly, they are intended to involve more people: not just individuals, as patients' forums did, but networks and organisations so that patients' voices are heard from many different and organised perspectives. Thirdly, they will cover social care as well as health. LINks will be established for an area and, for the first time, will consider all the health and social care services used by people within the area. This is a huge advance.

Why do we believe that these changes are necessary? First, without wishing to diminish the work of patients' forums in any way, there have been significant new configurations in the health and social care system, not least the move towards greater coterminosity between PCTs and local authorities, and greater joint commissioning across health and social care. But more importantly, the experience of many patients is that they cross services as they require care; for example, a stroke patient may experience services that range from care in an acute hospital, a specialist stroke unit, a rehabilitation unit and then they may need social care. Therefore, if local people are to have a key voice, it makes sense that they are able to speak up on all these stages and issues. LINks will be able, by virtue of their role and larger membership, to consider the whole patient journey.

So LINks will do the following things. Their role will be to collect the voices of the local area with regard to health and social care services across the sector; to monitor the range and quality of care services; to consider, report on and make recommendations about all relevant services; and to promote greater public involvement. To allow them to do that effectively, properly trained members of the LINks will have a power to enter and view services, just as the patients forums do now. That will include health and social care premises as appropriate.

How will they be organised? The Bill requires local authorities to make contractual arrangements for the support of these networks: procuring an independent host organisation, well versed in health and care issues, and likely to be from the voluntary and community sector, to support the LINk in carrying out its activities to facilitate user involvement.

The Bill, deliberately, does not set out detail of size and shape of membership or governance. That must be the responsibility of the LINk organisation itself; we will support the process by providing model contracts and guidance, but that must be locally owned and designed. Currently, there are nine early-adopter schemes which are not pilots, but areas which are working through these issues. Their experience will inform our guidance and the support we will give the emerging LINks.

LINks will be independent, as are patient forums. They will build on the best work of patient forums and we would encourage all forum members to become involved in their LINk, as the experience they have built up over the past three years will be invaluable to the success of the new system. As I think you can see, these changes are driven by a genuine desire to involve more people. They will be locally hosted and driven and they will set their own priorities locally.

In conclusion, you will no doubt agree that this is a wide-ranging Bill. So much so that there are some elements that time does not permit me to cover, but I hope I have demonstrated how seriously we are taking this opportunity to give local government, local partners and local people the tools and support they have asked for. We are putting the trust in local government and communities to find their own solutions that best respond to local needs and to shape their own agendas. It is for them to rise to the challenge going forward.

I should note that we still have some improvements to make to the Bill, and we will be bringing forward some amendments in Committee. Indeed, we have received a most helpful report from the Delegated Powers and Regulatory Reform Committee, to which my noble friend Lady Andrews will be responding. It may be that we will wish to bring forward some amendments to address their recommendations. I look forward to robust debate on the Bill, both today and in the coming weeks. I commend the Bill to the House.

Moved, That the Bill be now read a second time.—(Baroness Morgan of Drefelin.)

Photo of Baroness Hanham Baroness Hanham Deputy Chief Whip, Whips, Shadow Minister, Scotland, Shadow Minister, Transport, Shadow Minister, Communities and Local Government 3:53 pm, 20th June 2007

My Lords, I thank the Minister for presenting the Bill in such a lucid way. It is very nice to see the noble Baroness, Lady Andrews, in her place. She struggled manfully—or womanfully—through the Greater London Authority Bill last night. We all thought she was very brave and we felt very sorry for her. I am extremely surprised that she is here today: our very best wishes to her for a quick recovery and a return to her normal robust health. We are also looking forward to the maiden speeches of the noble Baroness, Lady Campbell of Surbiton, and the noble Lord, Lord Mawson. We very much look forward to hearing what they have to say.

Before I start, I declare an interest as a member of a local authority, the Royal Borough of Kensington and Chelsea. I suppose, in view of the later aspects of the Bill, I should also put on the record that I am chairman of an acute trust, so that that is clear.

I appreciate that this rather large and cumbersome Bill has come about in response to a number of local government concerns that have arisen since the Local Government Act 2003 was implemented such a short time ago and that there have been detailed consultations on the proposals now included. However, one might say that this is indeed an epic tale with a considerable number of shorter stories.

As the Bill makes major changes to the patient and public involvement in health and social care by the abolition of the recently formed patients' forums, as the Minister said—I remember well the exchanges between the noble Lord, Lord Hunt of Kings Heath, and myself on the setting up of the patients' forums and look forward to seeing how that works out again—and the introduction of LINks, my noble friend Lord Howe will be speaking on these clauses today and will, when possible, be on the Front Bench for their remaining stages. My noble friend Lord Roberts will do the same for the provisions on Wales. My noble friend Lord Hanningfield will wind up this debate for us today and will specifically address local area agreements, best value and targets.

We accept, as the Minister said, that there are some areas where progress has been made—for example, in the development of targets and changes to targets—but we do not believe that decentralisation from the Government to local government has yet gone anywhere near far enough to give local authorities the ability to really manage their own affairs. Unfortunately, where we take one step forward, we usually manage to take two steps back.

We have heard a great deal about the Government's support of localism, but their apparent enthusiasm is still fundamentally unmatched by this legislation. The Bill is a missed opportunity to devolve powers over planning, housing, transport, skills and economic development from national and regional government or quangos to democratic local councils. It signally fails to address the Government's aim of civic engagement and securing economic prosperity, and leaves in place the whole tier of unelected regional government, something a future Conservative Government will abolish.

The Bill does not contain any proposals on the crucial issue of the reform of the local government finance system. It is strange but obvious that the Government are not going to grasp this nettle. The recommendations in the long-awaited and singularly undiscussed Lyons report have no mention in this Bill and the whole report is seemingly back in the long grass, while the CSR 2007 is due in the autumn.

To grasp fully its place-shaping role, local government needs to have a coherent and sustainable finance system. So, presumably, although the Bill is now under way, there is no appetite on the part of the incoming Prime Minister—the former Chancellor of the Exchequer, who commissioned both the Lyons and the Barker reports—to take matters any further. One cannot blame him. Indeed, one can only applaud the common sense of leaving matters alone, particularly where, by doing so, the Government avoid the predictable unpopularity of a council tax revaluation. However, an enormous amount of time, money and energy has been expended on the production of these reports which have, so far at least, had comparatively little impact.

The first four parts of the Bill are devoted to reorganisation of the structures of local government. Indeed, the ink was barely dry on the early discussions in the other place of the proposals for limited extension of unitary government before invitations had been issued by the Secretary of State to a number of authorities to apply to be one of the first involved. As a result, a number of counties have applied to dissolve their districts and become unitary authorities, districts have applied to amalgamate to become unitaries, ballots have taken place which resulted in support for the process, and further ballots have taken place which have gone the other way, even in areas which had originally voted in support. Permission has been given to a district for a judicial review of the whole process being undertaken by its county. What a mess.

What is it for? There appear to be no principles attached to this approach to reorganisation, just a vague feeling that some areas want to become unitaries. The Government are committed to there being no further invitations beyond those already being considered. They have indicated that no further reorganisation along these lines will be entertained. An even clearer view is emerging that fewer than 10 will, in the end, be sanctioned.

In her opening remarks, the Minister said that decisions will be made by the end of July, but all of this is before the principle of developing more unitaries has been agreed by Parliament. Of course, the Minister will tell us that no new bodies will be created without an affirmative resolution to regulations to do so, but that is the end of a road that has had no beginning and no consent as far as Parliament is concerned.

The Government were certainly right to sunset the Secretary of State's power to direct reorganisation, but their whole approach must be questioned, and we will be doing so. What are the principles, as opposed to the criteria, underpinning their approach to reorganisation? How long will the chaos that is being engendered continue? What has happened to two-tier pathfinders? What incentives are there to support closer working in two-tier areas?

There are also proposed changes to the executive arrangements that will require local authorities to operate one of three models. While the aim of strengthening the council leader's role is welcome, the level of prescription that the Bill entails is not. Councils should be free to decide their arrangements, including returning to having a committee system, if they wish, rather than the current arrangements for scrutiny. The model of an elected executive model seems incoherent and requires much more clarification.

The further strengthening of the role of overview and scrutiny is an admission that this aspect of the reorganisation under the Local Government Act 2003 has not yet found a proper role. It is ironic that so much effort has had to go into ensuring that the remaining members of a council, who do not find themselves in the echelons of the cabinet, spend their time involved not in making decisions about their local community and the council's policies and actions but in trying to find out what is being done in their name.

Local determination of the timing of the electoral cycles and warding arrangements being locally determined are largely acceptable.

There will be differing views, depending on the part of the country, on the formation of parish councils following a community governance review. While this may be unremarkable in counties and districts, it would be highly contentious in London, where there is already local representation through the boroughs and a second tier of government. London already has too many tiers of government; the Mayor is proving to be an enormous expense, and parish councils would add a further precept on Londoners' council tax. There are already a number of councils where there are area or neighbourhood committees that decide local issues. They are similar to parish councils. The introduction of this extra tier could cause great confusion.

No tears will be shed over the abolition of the best value performance reviews, and the excessively centralised performance indicators, which have involved onerous inspection regimes, will not be missed. My noble friend Lord Roberts will, I am certain, have something to say on the fact that these provisions will not extend to Wales.

There are many other aspects of the Bill that I do not have time to mention—much like the Minister—and some will be dealt with in more detail by my noble friend Lord Hanningfield when he winds up; and, as I have previously said, my noble friend Lord Howe will speak on the clauses and chapters on patient involvement. However, I do want to deal with Part 10 and the conduct of local authority members.

It is only a few months since the Government issued a revised code of conduct under the provisions of the Local Government Act 2003. The provisions have not yet been finally signed off in many authorities, and while they encompass such matters as the exclusion of actions carried out in the members' private, rather than public capacity, which were helpfully clarified as a result of the Livingstone case, there is now another whole chapter of provisions on both the code of conduct and the work of the standards board. Members of local authorities have the right to think that the problems that arise are mostly of a comparatively trivial nature and that there are limited ones which have any substance to them. The Government are moving into overkill on these matters. Would it not have been better to bring them all together so that they could have been considered at one time and the code adjusted once? The codes of conduct are now having to be signed off by local authorities, so that they can then be revised again as a result of the Bill.

Finally, new measures were introduced in Committee in the other place designed to achieve economies of scale in waste treatment and disposal services. We are broadly supportive of these as they will undoubtedly save money, but in Committee we will want to look at the exact way in which those provisions are drawn.

The Bill is full of significant measures for local government. The number of speakers waiting to have their say is a testament to the interest that will be taken in it. Both my noble friend Lord Hanningfield and I look forward to the further stages, to testing the thinking behind the provisions, and to encouraging the House to make changes where we think they are required.

Photo of Baroness Hamwee Baroness Hamwee Spokesperson in the Lords (Regional & Local Government), Department for Communities and Local Government 4:07 pm, 20th June 2007

My Lords, I, too, thank the noble Baroness, Lady Morgan, for introducing the Bill, especially as the Bench was barely cold from last night. I hope that the noble Baroness, Lady Andrews, regains her voice and has no cough very soon. My noble friend Lady Scott of Needham Market should have been leading for these Benches. She is not here due to a family bereavement. She will be back in full flow very shortly, but this is very much her speech.

A local government Bill should give us some real opportunities to rebuild local democracy, empower local government, provide councils with the resources that they need and restore confidence in local government, which, as we have heard this afternoon, is to become "more visible". I wrote that down with a question mark. This should be a chance for a more equal partnership between central and local government, as we see elsewhere in Europe and around the world.

We welcome the chance to debate the Bill. I particularly look forward to the maiden speeches of the noble Lord, Lord Mawson, whose work in Bromley-by-Bow is an extraordinary example of taking forward what can happen in a local community, and of the noble Baroness, Lady Campbell of Surbiton, who brings so much experience to the issues that we will be debating. I am also looking forward to, although not a maiden speech, the speech of the right reverend Prelate the Bishop of Peterborough, whose parishioner I was until he became very grand and moved. I know that he knows a thing or two about community affairs.

The noble Baroness, Lady Hanham, described this as a missed opportunity and a disappointment; my noble friend, too, gave me those words in her notes. They are more polite than I am, or perhaps they are using Lords-speak. I have to say bluntly that I regard this as a bad Bill. It purports to be decentralising, but it does not address the most centralising feature of local governance, which is finance. Public accountability for funding decisions is blurred because so large a proportion of funding comes from central government. We have an annual round of claim and counter-claim between the centre and local government. I agree with the noble Baroness that the Lyons review was a wasted opportunity. The Government now seem retrospectively to be trying to shoehorn much of what Lyons said into their agenda.

Council tax is still with us. Noble Lords will not be surprised that I take this opportunity to say that it needs to be replaced by a fair tax based on ability to pay. There is a wide call to return the uniform business rate to local control. I am interested in the proposals for the supplementary rate, but they raise many questions in my mind. We need a reduction in the ring-fenced grant and the other central controls on how local councils make—indeed, have to make—spending choices.

The Bill does not include measures to make local government more representative and responsive. Noble Lords will have received a briefing from the Electoral Reform Society, which states that there is a glaring omission of any reference to reform of the electoral system. We are all aware of the one-party states around the country and the dangers of councillors becoming out of touch as a result. I say that having been a councillor on a London borough at a time when we held 92 per cent of the seats on49 per cent of the vote. I thought that that was wrong, then; I think that it is wrong now.

Nor does the Bill address one of the great iniquities of our time: the quango state. Quangos, trusts and boards spend more money than local authorities. It is time that we had proper democratic oversight of those bodies. The Bill highlights the problems caused by the absence of a constitutional settlement for this country. Council structures, functions and governance are completely at the whim of central government. The Bill proposes two major structural changes: the creation of unitary councils in some areas and the introduction of new models of governance that place all executive power in the hands of a mayor or a so-called strong leader.

What exactly are the Government seeking to achieve? Many of us have debated these issues in this Chamber with extraordinary frequency. There is change after change, but never time for the new provisions to take root and, most particularly, no time for assessment. We have seen the development of a whole new industry of inspection, audit, analysis, target setting and performance management. When I was a local councillor in the 1980s, I welcomed performance management. It took the form of advice that one could consider—benchmarking and so on. It has changed dramatically since then, but by every measure that the Government have thrown at local councils—Gershon, comprehensive performance assessment and so on—local councils have improved their performance dramatically and there is evidence of real commitment and willingness to improve right across the board.

However, there is no evidence that strong leadership leads to better performance. When I use that term, it is almost always in quotation marks for the purposes of this debate. There is no evidence that the reforms proposed in the Bill will do anything to improve the process. Indeed, it seems to us that there is a danger that focusing on structural reform will cause councils to take their eye off the ball of serving their local communities. The evidence from the last round of unitary creations is that it takes some time—years—for their operational effectiveness to reach the level previously held, and then even longer to get ahead of that.

If the Bill is not about improving efficiency, value for money and service delivery to local citizens, what is it for? How can there have been a numerical limiton the number of unitary authorities to be created before the principles are set in place? It is not clear to us how the Government intend to balance the elements of the costs of reorganisation, operational efficiency or the loss of it, and local interests and aspirations. Surely it must be for local people ultimately to decide what happens in their area. That is true for overall structure and for governance.

I am not aware that the Government have any evidence that a particular style of governance—elected mayors, in particular—makes any difference to the performance of an authority. Do the Government accept that, with the infinite variety of situations across the country, we should avoid seeking to impose a limited number of models? Why is the status quo not an option? If the Government are so confident that their favoured models are right, why do they not leave it to local people to come to that view themselves?

In 2000, I was instrumental in increasing the population limit that would allow small authorities to opt for "alternative arrangements"—in fact, those were what we started with, so I find it quite difficult to think of them as alternative arrangements. That gave them wider choices. Some authorities exercised that choice and have moved on to other models. There have been 32 referendums on the establishment of mayors and in 20 cases the proposal has been rejected. In four of the 12 cases that went ahead, there are active campaigns to get rid of the mayors. It almost defies belief that the Government's response to this clear expression of local choice is to remove the referendum requirement and to leave the decision to the council without going to the people. Councils do not necessarily want that.

Colleagues of mine have met the leadership of the City of Durham Council, which is involved in what I understand to be a "people say no to giant councils" campaign. I believe that in Doncaster a petition of 11,000 signatures was presented to the council with a motion to call for a referendum, which was agreed. But there has been procrastination on the part of the authority and it looks like this Bill will lock the petitioners—that is, local people—out of the process. That cannot be right.

The devolving of all executive power to one individual flies in the face of reality on the ground in the many areas where there is no single-party dominance and the council is in no overall control. There has to be concern over the adoption of this model, under which one might change to a single-person executive or a slate. The election of a slate put forward by the new leader could cause by-elections, which I cannot see being popular with local people. What happens if the balance of the authority changes as a result of those by-elections? I remain puzzled.

I appreciate that I should probably have worn purple today because I am presenting myself as the grumpy old woman that I am. When I became a councillor, the old committee system held sway. There was not the division between front-bench and back-bench councillors or the alienation from decision-making that we all feel is such a real risk. Calling councillors who do not hold executive responsibility "front-line councillors" will not fool anyone.

My noble friend Lady Scott says, "Why on Earth will people want to stand for election simply to be scrutineers?". From my point of view, in London, which is very much bigger than any of these authorities, I value scrutiny, but it is a different situation and I support her point. I find great difficulty with the notion that not all councillors would be local ward councillors. When you look around at the great achievements of local government in the 19th century and the earlier part of the last century, you see that gas, electricity, sewerage, education and health were all delivered under the committee system.

My noble friend said that I should reassure the Government at this point that we do not have quite such issues of principle with the other local government parts of the Bill, although we will want to look at the detail of, for instance, local area agreements in order to understand how they are to work in practice. The term "partnership" is used a great deal in this context. I have always felt that a partnership should be something organic and voluntary. Imposing particular models of partnership, such as where just a couple of districts speak for all the districts in a county, feels false and risky. We welcome the strengthening of parish councils, particularly the extension of the general power of well-being, but we have concerns, which we shall raise, about non-elected parish councillors. We will come to the Standards Board in Committee. It has responded to criticisms, but the process has been overly bureaucratic and centralised. I would still like to see a rather different regime.

My noble friend Lady Neuberger, who is not a grumpy old woman, will deal with the health parts of the Bill. For my part, I deplore the sequence that has led from the dismantling of community health councils, through the abortive commissions for patient and public involvement, to the new LINks system.

We will spend a lot of time on these matters in Committee. I conclude from these Benches by saying that we do not see the Bill making any real contribution to the rebuilding of strong local democracy or improved provision of services to our citizens. It has been put to me that we must beware of incremental change that might actually lead to a loss of democracy.

Photo of Baroness Campbell of Surbiton Baroness Campbell of Surbiton Crossbench 4:21 pm, 20th June 2007

My Lords, it is with great pleasure that I address your Lordships' House for the first time. My breathing does not permit me to give long speeches, so noble Lords will be pleased to know that I will seldom exceed seven minutes. I wish to begin by paying tribute to the late Lord Carter. His encouragement and support over the years is one of the main reasons I am in this House today. I should like to thank also my sponsor, the noble Lord, Lord Ashley. I have had the pleasure of working with him for over 15 years, and he has given me terrific and great inspiration. My thanks also go to the noble Baronesses, Lady Finlay and Lady Wilkins, and to others who have patiently answered my endless questions. I also wish to thank the staff of the House. Their enlightened approach to my access needs has been most welcome. As a disability rights commissioner, I am happy to inform your Lordships that this place is one of the best models of good practice under the DDA that I have ever come across.

I have chosen this Bill for my maiden speech because most of my adult life has been spent helping under-represented groups fully to participate in their communities. I began my working life in local government as a disability awareness trainer, and I soon understood that disabled people needed to define the solutions to our own problems. Otherwise, public policy would fail. The term,

"nothing about us without us", became our mantra in the late 1980s, and it has been our guiding principle ever since. I went on to become highly involved in campaigning for anti-discrimination legislation. That led, eventually, to the Disability Discrimination Act 1995. In parallel to this, I also campaigned for community care direct payments, and the noble Lord, Lord McColl, was strongly supportive, along with a large number of Members of this House. In both cases, disabled people fully shaped the legislation, and I think that is why it has been so very successful.

These experiences demonstrated to me the importance of public involvement in shaping services, so I was thrilled to join the Department of Health's expert panel on public and patient involvement last year. This panel was tasked with looking at one of the proposals in the Bill; the setting up of local involvement networks, or LINks.

As your Lordships know, LINks will replace the current patients' forums. My overriding reason for supporting the introduction of LINks is that they will bring together health and social care while placing greater emphasis on joined-up user and public participation. People like me who use both health and social care services seldom differentiate between social care support and health interventions. We need a holistic approach so that we are not bogged down by multitudes of different professionals, each armed with assessment forms which go on for days. Social care has a long and successful history of user involvement. Bringing it to work in an integrated way with healthcare within these LINks will bring a rich dimension to the public involvement described in the Bill.

The exciting thing about LINks is that they will be supported by host organisations, one for each local authority. There is no blueprint for a LINk and that is what is so good; each will evolve to suit local circumstances. This is a great opportunity to use the energy and creativity of a whole range of diverse stakeholders; for example, centres for independent living run by disabled people. They are, after all, the experts by experience in health and social care. They will be key members of LINks. What is more exciting is that, at last, they may also be excellent candidates for the role of a host.

To make LINks truly valuable in their local communities, they need to be opened to the widest range of user voices. This includes people with all types of impairments, people from minority ethnic communities and even people living in residential care. Consider how enabling LINks could be for older people. Their large and growing numbers mean that they are under-represented in local decision making. There is increasing evidence that they are often exploited, neglected or abused, but their voices are seldom heard. I believe that the measures in the Bill will go a long way to empowering such groups actively to improve their health and wellbeing.

I am excited about some parts of the Bill which signal a culture of greater inclusion. As a new commissioner on the Commission for Equality and Human Rights, it is my responsibility to ensure that public services empower and involve all members of the public. We need inclusive communities where no one gets left out. Parts of the Bill take us in that direction.

Photo of Lord Low of Dalston Lord Low of Dalston Crossbench 4:29 pm, 20th June 2007

My Lords, I count it a privilege to offer the congratulations of the House to the noble Baroness, Lady Campbell, on what I am sure all your Lordships will agree was a most impressive and powerful maiden speech. It was notable for its alliance of institutional analysis with a passionate concern for the spirit which should inform those institutions, a spirit which has informed the whole of what the noble Baroness has devoted her entire adult life to advancing. I am in a good position to know this as the noble Baroness and I go back quite a long way—nearly 25 years, in fact. The causes with which we have been identified have marched, to a fair extent, in step with one another.

We began our association in the dying days of the GLC. There are not many people around who are prepared to admit to that these days. The noble Baroness and I fought a kind of last-ditch stand in support of the disability resource team, where we both worked. That was quite successful, although the same, alas, could not be said for every part of the GLC. We have both since been intimately involved, as the noble Baroness has said, in the campaign for anti-discrimination legislation and inclusive education for disabled people. We came together again somewhat later as DRC commissioners, promoting and monitoring the implementation of the anti-discrimination legislation for which we had both fought.

The noble Baroness has also led in fields with which I have been less concerned. She mentioned direct payments and the new Commission for Equality and Human Rights. I would add the work she is currently leading on independent living for disabled people. Your Lordships should be in no doubt that we now have in our midst a big hitter, a mover and shaker of formidable talents, but one who is also subtle and persuasive. The record of her achievements attests to that. I am sure it will already have become obvious to your Lordships that we can look forward to benefiting greatly from the noble Baroness's counsel and inspiration.

Like the noble Baroness, I shall talk about Part 14 of the Bill, which concerns patient and public involvement in health. Although it takes up half the title, it is buried away somewhat obscurely in a Bill that is principally concerned with local government. Like the noble Baroness, I can see the attraction of the proposed local involvement networks in bringing together health and social care, but I have many more reservations about the process by which we got here and the amount of detail that still needs to be filled in before we can have confidence that we have a mechanism that is truly fit for purpose. I am reassured that noble Lords who have spoken have picked up some of the same imperfections.

In truth, if we track back, the gestation of the networks presents a saga of false starts, U-turns and changes of mind that are not an object lesson in how to run a railroad. I will not try your Lordships' patience with the gory details; suffice it to say that for much of the time it appears that the Government have simply been making it up as they went along. For instance, they wish to replace the four-year-old Commission for Patient and Public Involvement in Health and patients' forums. Apparently, however, they have wanted to do so almost from the moment they set them up. At the same time as they were setting up these bodies, the Government were simultaneously planning to dismantle them. That is hardly a shining example of joined-up government. Indeed, I believe that the commission has already been abolished and given a further lease of life on no fewer than six occasions. Those who have been in your Lordships' House longer than I have can therefore be forgiven if they have a sense of déjà vu.

As for what is missing and still needs to be filled in, the Health Select Committee in another place described the proposed changes as "vague and woolly". So they are. The Bill is silent on the membership, structure and accountability of LINks or the infrastructure to underpin them. Indeed, the Minister sought to make a virtue of the lack of infrastructure, but I venture to think that your Lordships will find that less than convincing.

Where the Bill is clearer, such as about plans to impose significant limitations on the rights of entry, the Government's motives are opaque. Nevertheless, there seems to be a widespread consensus that improvements in patient and public involvement in health are possible. I welcome the Government's obvious desire to secure such improvements and hope that the Bill can be made to serve as a vehicle for achieving that.

However, there remain many doubts. The Government are seeking improvements by abolishing the one national supporting body for public involvement in health—the commission—just before setting up 150 new bodies—the LINks—which will all need resourcing over the recruitment and training of volunteers, and so on. They recognise that the LINks will want or need to set up their own national body to support them in due course. Is the Minister confident that a hiatus between the current regime and the next is really the best way forward, being, as it is, devoid of any transition arrangements or arrangements for training and the transfer of skills?

I am afraid that the department's assurances to the Select Committee that it was in discussion with the National Centre for Involvement, together with its reliance on publishing departmental guidance to LINks once the Bill is passed, give the impression of a measure brought forward before it is ripe. In any case, the National Centre for Involvement is not really the body to perform this role. It is rather an academic body, with only a fraction of the commission's budget; it was set up to give policy advice to the NHS rather than provide hands-on support to local consultative forums. I share the enthusiasm of the noble Baroness, Lady Campbell, for a new culture of inclusion and look forward to seeing her taking a lead in its creation. She is right that LINks need to be open to the widest range of voices, yet the Bill is silent on the right to be consulted, which the forums have had. That is why I hope the Minister will be able to provide concrete detail on the department's future plans and put such detail in the Bill.

There is much expertise in this House which could be tapped to improve the Bill. However, if all the substance of the new system will emerge only in subsequent regulations and guidance, Parliament will not, despite the name of the Bill, have a proper involvement in shaping patient and public involvement in health.

Photo of Lord Clarke of Hampstead Lord Clarke of Hampstead Labour 4:37 pm, 20th June 2007

My Lords, I add my congratulations to the noble Baroness, Lady Campbell. I am sure that her clear insight into so many of the problems in our society, mentioned in the Bill, will be of great benefit to the House. I hope that we can look forward to repeat performances of her informative and excellent speech while we debate the Bill in the days and weeks to come.

The Second Reading of what is quite an extensive Bill presents the House with an opportunity to make comments and suggestions that will I hope lead to an excellent Act of Parliament and bring about improved benefits for the people who need and rely on our health and social services.

I am disappointed that the representations made by Burnley and Pendle councils that they should become a unitary authority have so far been unsuccessful. During the consultation period, I wrote to the Secretary of State, adding my support for what Burnley and Pendle had suggested. I declare an interest in that I chaired the taskforce that examined the sad events that occurred in Burnley in June 2001. It was invited to make recommendations within an action plan for the future. Included in the 80-plus recommendations that we made at the time was that Burnley Borough Council should put its view, and that of a number of its partners, regarding the benefits of a single unitary authority to Government during the consultation on the then forthcoming White Paper on regional government.

The arguments for unitary local government are compelling. It can deliver local services at lower cost; it is more accountable for its services because there is a greater transparency for who is responsible for them. It can also bring a joined-up approach, leading to higher quality services. In contrast, I believe that two-tier local government is less economic, responsive and coherent.

As has been mentioned, the Government are considering 16 unitary bids. They have rejected bids from district councils in Lancashire. If the 16 bids are successful, Lancashire will, as I understand it, be the only remaining two-tier shire area in the whole of the north of England.

There are special reasons why I believe that the unitary solution is so important to local government in Lancashire. In my report into the 2001 disturbances, I recommended that Burnley council should pursue this unitary status because in my opinion, a unitary council would be better able to build cohesive local communities. I shall briefly explain to the House in more detail why I wish to press the case for unitary local councils in Lancashire.

Common sense would suggest that two tiers of local government cost more than a single tier. Taxpayers' money is being wasted on two cohorts of councillors, two sets of senior managers, two lots of council buildings and even duplications in services. It is estimated that savings from the 16 bids being considered by the Government amount to £200 million. The business case submitted by Burnley and Pendle showed that creating a unitary council for the two areas would deliver savings of between £2 million and £8 million per annum.

Common sense suggests also that when two different councils provide local services, it is not always obvious who is responsible for what. This confusion leads to dissatisfied residents being passed from pillar to post. Why? The district council cleans the roads, but the county council maintains them; the district council provides the housing adaptation grants, but the county council makes the assessment of need; the district council decides street names,but the county council replaces streetlights. This confusion about services in two-tier areas leads to a democratic deficit. In districts such as Burnley, there is often a strong sense of local identity, with people looking to the district council to fix their problems. However, the vast majority of local taxes collected by district councils is passed upwards to the county council. The county council makes the big decisions, often many miles away from local communities and with little understanding of local concerns. In Burnley, while the six county councillors in Preston have the power to spend the money, it is the 45 district councillors who feel the democratic pressure and do the majority of the constituency casework.

Unitary councils are better able to deliver quality services, because they can devise coherent, joined-up services. The Government recognised some time ago that if we want to encourage enterprise, increase community safety and improve people's health, we need joined-up government. A significant barrier to this is two-tier local government.

The borough of Burnley has some of the country's highest levels of deprivation, worklessness and crime. Educational attainment is low and life expectancy is below national averages. However, Burnley is also a place of great potential. It has beautiful rural settings; it attracts hundreds of millions of pounds of investment in the town, which has a unique industrial heritage. The diverse people of Burnley have a strong sense of community. In other words, Burnley faces the same tensions and challenges as our cities, but unlike our cities, is not led by a unitary council. Meeting these challenges requires strong leadership, which is a key element of the Bill. Strong leaders have a clear vision and a shared strategy.

Two-tier local government is surely a barrier to this. I shall give noble Lords a practical example. Local councillors in Burnley know that the long-term sustainability of the town is dependent on increasing the skills and attainments of its young people and encouraging new enterprise. Despite this, and following lengthy negotiations, the district council had forcibly to evict the county council from a gritter depot so that the site could be used for a new sixth-form college, university faculty and business park. Meanwhile, the county council resorted to a compulsory purchase of land from the district council to build a new secondary school. If we want to see a transformation in the quality of life in a place such as Burnley, we need a local government structure in which a single accountable council is able pull local services in the same direction to suit local needs.

As neighbouring councils, Burnley and Pendle submitted a joint bid for unitary status to the Minister. It was a first-class submission. The two areas face many of the same challenges, and local councillors share the same aspirations for their areas. The bid passed every criterion set by the Department for Communities and Local Government except one, and, for this reason, was rejected. All the bids in Lancashire were turned down because they did not address the remaining two-tier structure across Lancashire.

I share the views expressed by Members of Parliament for the constituencies in Lancashire. In a recent debate on this issue in Westminster Hall, overwhelming support was expressed for calls for the Government once and for all to resolve local government organisation in Lancashire. I, too, encourage the Secretary of State for Communities and Local Government to look at this as a matter of urgency.

I turn to another matter that emerges from the Bill: the role of the primary care trust in the east Lancashire area, formerly the Burnley, Pendle and Rossendale PCT. It is an award-winning PCT and got its awards mainly in the field of patient care. In its new form, the East Lancashire PCT is already demonstrating the benefits to be derived from formerly separate groups working together. Will the Minister assure me that nothing in the Bill will jeopardise the current structure, which is working so well?

In outlining the Bill's key themes the Minister referred to the need for strong local leadership, and as an old local councillor in a London borough I welcome that. I was fortunate enough to serve under some very strong leaders in Camden, and believe that strong leaders are essential for creating strong communities and providing high quality services. It is my experience that there is better accountability and greater levels of participation when people know who is in charge, and the evidence shows that the new leadership models introduced in the Local Government Act 2000 have brought real local benefits. So it must be right now to strengthen and further build on these models. I note and welcome the fact that these leadership proposals have been welcomed by both the LGA and local government. The evidence also shows that direct elections provide the strongest and most visible local leadership. But I agree that the decision on whether areas should elect a directly elected mayor should be a local one.

The Bill requires that local authorities which currently operate executive arrangements move to one of three new leadership models: a directly elected mayor witha four-year term; a directly elected executive with a four-year term; or an indirectly elected leader with a four-year term, where the council operates whole-council elections. The Bill means that all council leaders and mayors will serve a four-year term and that all executive powers are vested, including powers to appoint other members to the executive and allocate portfolios. The Bill seeks to introduce provision to enable local authorities to adopt either a directly elected mayor or a directly elected executive without the need for a referendum. As I understand it, people will still be able to demand in a petition a referendum on a mayoral or directly elected executive model. Local people will, as I understand it, be fully involved in these decisions. Before drawing up proposals to change executive arrangements, local authorities must consult local government electors and other interested parties. All of those facets are to be welcomed for involving local people. Local government electors will be able to petition their authority to hold a referendum on a mayor or directly elected executive, and local authorities will be expected to consult widely before deciding to adopt a directly elected model. Local people will still be able to demand a mayoral referendum.

I welcome so many facets of the Bill but it would be wrong for me to take up more time now to say so. There will be many more opportunities to look closely at some of the issues that the Bill raises. For now, I simply express the hope that the Bill will have a constructive passage in the days to come. I conclude by wishing my noble friend the Minister a quick and speedy recovery to full health.

Photo of Baroness Cumberlege Baroness Cumberlege Conservative 4:48 pm, 20th June 2007

My Lords, I, too, congratulate the noble Baroness, Lady Campbell of Surbiton, on a very courageous speech, and I look forward very much to the speech of the noble Lord, Lord Mawson, of Bromley-by-Bow, whose centre is a national inspiration which is led by an inspired leader.

Like many parliamentarians I started my public life in local government. At the age of 22, I stood for election to the Chailey rural district council. The previous election had been fought the year before I was born. In my part of Sussex, democracy was somewhat suspect. My first election was splendid: four candidates for two seats and I topped the poll. I topped the poll because my father, the local family doctor, was hugely respected and loved. Knocking on the door of one elderly tenant, I was told that she and her sister might vote for me, although I was very young, because I had "the doctor's eyes". If democracy was suspect, party politics certainly were. I quickly became a local government addict and served on the county, district and parish councils all at the same time. It was rewarding, not financially because our only claim on the public purse was for travel, but we took pride in our communities and knew them inside out. We shaped them. We bought land, built houses and allocated them. We were responsible for huge tracts of public land such as Ashdown Forest. We regenerated run-down areas and the port of Newhaven, and we did so much more. We had the freedom to do such a lot, and without a doubt we improved the lives of our electorate. So I very much welcome any measures in this Bill that give more autonomy to local people and reject those that do not.

In 1982 I was appointed to chair the Brighton health authority by the then Secretary of State, my noble friend Lord Fowler. He is now my friend but at the time I had not even met him. It was he who introduced me, or rather seduced me, into the management of the National Health Service. Rather than draw on very outdated knowledge of local government, I reserve my comments for Part 14—the section on patient and public involvement in health.

Regarding the NHS, the Government have had an insatiable and unhealthy appetite for destruction—a sort of Maoist tendency for constant revolution. The noble Lord, Lord Hunt of Kings Heath, will remember our splendid battles in this Chamber to retain the much loved community health councils. But they had to go and be replaced by health forums. The Government argued that CHCs were variable and ineffective. That is a fallacious argument when primary care trusts are variable, hospitals are variable, schools are variable and human nature is variable. But the Government decided that CHCs had to go.

The resilience of the British people has to be admired. Despite being roundly snubbed some CHC members did not give up and volunteered to join the new forums. Altogether around 5,000 volunteer forum members were recruited. But these dedicated men and women, who are prepared to do so much for their local communities, just four years later are to be snubbed yet again, and sacked. We do not know whether the new system of links introduced in the Bill will work, but I am very encouraged by the noble Baroness, Lady Campbell of Surbiton, who was an architect of this new idea. However, I am sure that if we are to avoid constant revolution, and if another cohort of willing volunteers are not to be swept away yet again, we, the legislators, must be brave enough to allow for flexibility and not be tempted to impose rigid structures. Only then will these new links be able to keep pace with the changes in our institutions, which in turn should reflect the changes in society.

I welcome the philosophy which underlies the establishment of links—the return to closer community involvement, the responsiveness required at local level, the devolved budget and the one-stop shop which serves a whole community. In fact there is a very strong resemblance to community health councils, which had and did all these things. The tragedy is that instead of exercising a little humility and working with CHCs to modify and resource them appropriately, the Government swept them away and replaced them with another untried, ill considered plan—health forums; this at the same time the Government were establishing foundation trusts, each with their own governors and members—all volunteers tasked with representing their communities' views.

The master plan is to make every hospital, every mental health trust, every primary care trust, every community, every combined acute-and-community, every ambulance and learning disability trust, into a foundation trust—a total of 425 in all. Each and every one of them is to have its own legion of volunteer members, as many as they can recruit, to feed in the community's views. For instance,St Thomas', a first wave foundation trust, has proudly recruited 6,000 members from its patients and local boroughs. It is to be congratulated on that, but it has taken a great deal of time and financial cost.

In addition, local authorities will have their own citizens' panels or similar organisations that need to recruit volunteers for public involvement. If your Lordships have not already been recruited, you soon will be. We will need all hands to the pump. No one will be spared. Every person in this country will be needed to feed the great machine of patient and public involvement. The cry has gone up that patients and public must be involved at every step of the way, regardless of whether those seeking our views are prepared to give time to listen, to take them seriously, or to act on our suggestions. We know that too often decisions have been taken long before our views have even been sought.

I believe in the wisdom of the crowd and in getting the views of people. I believe in listening to the public. I can think of countless examples where that has happened and far better and more appropriate services have resulted. Quite simple requests from those who use public services, when acceded to, can radically change the patient experience; but if patient and public involvement is to make sense and if the new proposals are really going to influence the delivery of services, they must be carefully thought through.

One of the strengths of the new system is its integration with local government. They will hold the contracts for the hosts for the LINks. However, what is not clear is where the accountability lies. The Health Select Committee expressed concern that if a LINk is failing, since the host has no power to change the LINk and the local authority would only be able to hold the host to account, who would take the necessary action, and how? If LINks are to be taken seriously, they need to be involved very early on in the planning and commissioning of services, long before ideas have crystallised. If that happens and they are seen as an essential part of the team, I can see them being a catalyst to get the right people into the same room.

When a PCT and a council are beginning to think about their commissioning plans for the following year, they should ensure that the LINk members are there to feed in their local knowledge and experience. They are there to knock heads together and to ensure joint commissioning between health and local government. I want to see them encouraging new and better practices, to extend the good things and to stop the bad things from happening. I want to see them not only exercising intellectual leadership in contracting, but being practical in resolving real issues.

For instance, more than 12 years ago this House was concerned about mixed-sex wards. I remember it well; I was in the firing line. That is a real issue which troubles the public and which flies in the face of dignity and respect when people are at their most vulnerable. I am told that nurses do not like single-sex wards. Nurses will tell you that an all-women ward is miserable, but put a man in there and women behave differently. I do not know whether that is true, but the public tell us that they want single-sex wards. That has been government policy for the past 10 years, but we still have mixed-sex wards. Perhaps the Minister could tell me how LINks would resolve such an issue.

The Health Select Committee had a number of reservations about the Bill. The RCN and the Commission for Patient and Public Involvement in Health have also expressed disquiet on a range of issues, as has Health Link, which carried out a remarkable survey on patient and public involvement. Their concerns centre around, among other things, conflicts of interest, the restrictions on visiting, maintaining independence, clear and coherent governance, sufficient resources, clarity on the words "significant" and "substantial" in the Bill, the absence of a national body to relate to other national bodies, such as Monitor, and so on. All those aspects will no doubt be teased out and tested during the passage of the Bill.

In conclusion, although I think that there is merit in these proposals, they need what this House is so good at: a bit of amendment, a bit of refining and careful thought so that we are not faced with another period of disillusionment as thousands of committed and willing volunteers are rejected and dismissed as being unwanted, unimportant and unloved. They have wisdom, knowledge and experience which can greatly enhance the quality and type of public services if they are given the opportunity, freed from endless upheavals, and are simply allowed to get on with the job.

Photo of Lord Greaves Lord Greaves Spokesperson in the Lords, Environment, Food & Rural Affairs 5:00 pm, 20th June 2007

My Lords, my noble friend Lady Hamwee said that she was a grumpy old woman—her description, not mine. I think that we should be careful about accusing people in your Lordships' House of being old. After all, as the noble Baroness, Lady Campbell, will have found, you think that you are getting old but then you come here and suddenly discover that you are young again—but not for long.

Grumpiness is a different matter. If people think that I am being grumpy in relation to this Bill, I shall hold my hand up and agree with them. The noble Baroness, Lady Hanham, and my noble friend Lady Hamwee both expressed disappointment with the Bill and thought that it was a missed opportunity. I agree entirely and add that some parts of it will cause a lot of harm if they are enacted in their present form.

I sat here in admiration of the speech of the noble Lord, Lord Clarke of Hampstead—at least, the part of it that was a eulogy to Burnley. He said what a fine town it is and how beautiful some of it is. It also now has some pretty good leadership. I am tempted to spend much of my speech pointing out that Burnley's twin of Pendle is even more beautiful, is an even finer place and has even better leadership, but I might be biased there. I declare my interest as a member of Pendle Borough Council.

This is an enormous Bill and it is full of an enormous amount of detail, yet it does not do very much at all to regenerate democratic local government in this country. At the same time, according to the Delegated Powers and Regulatory Reform Committee, it has 86 individual provisions for delegated powers. Therefore, we will end up not only with this big fat Bill in law but with a huge great pile of statutory instruments to add to it and goodness knows what else as well. What is it all intended to do?

The first part of the Bill is all about what I call external structures or reorganisation, perhaps turning some authorities into unitary authorities. Yet if it is true that unitary government is much better than a two-tier system, why on Earth are the Government being so timid? If it is not true—if it does not make much difference and the costs of reorganisation mean that it is not worth the candle—why are the Government doing any of it? It is extraordinary. I do not know how much of the Bill will survive the change in government when we get a new Prime Minister, but I sincerely hope that the noble Baroness, Lady Andrews, will survive the changes and will continue to provide excellent service to this House. She is an excellent Minister and, like everyone else, we hope that she will be fit and well to take part in Committee and in what the Minister today looked forward to: vigorous debate. I think that we will have vigorous debate, which will be good.

I want to put the Bill into an historical context. Like the noble Baroness, Lady Cumberlege, I was a member of a local council before the 1974 reorganisation of local government and I can remember what it was like then. When the noble Baroness was speaking, I was thinking back to the days when attending meetings meant that an item on the agenda would be discussed, a decision would be made about what to do and that would be put into effect. So often, that simple process does not take place any more. Everything is far too complicated; there are far too many constraints and far too many strategies saying, "You can do this but you can't do that". Councillors are elected for four years, but getting even little things changed can now take the whole four years or longer.

I remember the Redcliffe-Maud report of the late 1960s. That was a royal commission—those werethe days when we had royal commissions. The Conservative Government introduced the changes in the early 1970s, bringing in a two-tier system across the whole country, although in the metropolitan counties we had the metropolitan councils, which were not the most popular or exciting bodies and were done away with in about 1986.

At that time, the whole of English local government, outside London, was reorganised on the basis of an Act of Parliament that was about a quarter the size of this Bill. Instead of lots of detailed rules and regulations about how councils have to run their internal affairs, we had the Bain report, which was a committee of inquiry that looked at ways in which councils could run themselves more efficiently internally. That was purely voluntary and yet it was universally taken up across local government because it was put together on a co-operative basis. There was wide agreement on it. Instead of the old system of committees, everyone had a policy and resources committee, a service committee and sub-committees, and that system worked well for quite a long time.

My point is that that was done by consensus and by agreement. We did not need the avalanche of detailed primary legislation and even more detailed secondary legislation with which we have now been landed as the Government try to micromanage local government. I do not understand why that is now necessary and why we cannot go back to the system that we used to have. We should trust people. If they are elected to local authorities, if they run local authorities and are senior management of local authorities, we should trust them to do what they believe is best for their areas rather than trying to put everything down in detail. It seems that we cannot do that any more.

On the new structures, I echo everything that my noble friend Lady Hamwee said and a great deal of what the noble Baroness, Lady Hanham, said from the Conservative Front Bench. The new arrangements have been in place for seven years. In some places they are still bedding down and people are still getting to grips with the concept of overview and scrutiny, which, in the early years, was not a success; in many councils, it is still not a success, although things are improving. If that is the situation, we should allow people to get on with it and not interfere further. The idea of putting all the powers of a local authority in the hands of one person—the leader—is, in my view, philosophically wrong and practically very difficult. It will lead to a whole series of difficult situations locally when, for example, the control of a council changes. We can discuss that in detail in Committee.

The Government have taken note of the fact that many ordinary councillors are very dissatisfied with their role, as the noble Baroness, Lady Hanham, pointed out. The Government have invented this colourful new title, "front-line councillors". I can think only of those in the front line being shot first. As a councillor, I do not mind being shot if I have control of the decisions for which I am being shot. However, I object to being in a position of powerlessness, not being able to do things and still getting the blame. Many people in local government find themselves in that situation. Until quite recently, one never had the vast programme of councillor training that exists now. Nowadays, many councillors receive training almost every week; some of them get degrees in being a councillor from, I think, Salford University in the north-west.

What is all this about? In my view, it is very simple. It is a means of finding ways in which councillors can fill their time and think that they are doing something as a result of being elected when, in practice, they have far less power than anybody did before—apart, of course, from "them" if you are a front-line councillor, or "us" if you are actually running the council. There are ways of getting around it. I am on a council that involves all councillors through area committees, which is a very successful approach. But the more the Government try to impose detailed rules and regulations on councils and the way in which they run and site things, the more difficult it is for councils to overcome these difficulties.

We are going to have a lot of interesting discussions on the Bill. Local area agreements are an interesting and fascinating question. If I was a member of a compact unitary council, I might find the prospect of local area agreements quite exciting, as they put the council at the centre of the spider's web of the delivery of local services. In two-tier council areas, I do not understand how the agreements are going to work without severely emasculating district councils. The county council will be responsible for the local area agreement. Certainly in Lancashire, the local area agreement will not be in our area, will not be local and is unlikely to be done by agreement.

The two-tier system has worked well for most of the past 33 years. In many parts of the country, it has come to the end of its usefulness and we ought to move towards unitary authorities. Certainly, as far as Lancashire is concerned, I endorse everything about unitary authorities that the noble Lord, Lord Clarke of Hampstead, said, but we have been told that we cannot have it. We have to muddle on as best we can with this new system.

Issues of local democracy will come up time and again as we discuss the Bill. As councils get tied in to agreements with everybody else—many of them medium-term agreements—and as those agreements are on a county level and not a district level in two-tier areas, it will be difficult for people seeking votes in district council elections to explain just what a difference their election would make. As a result, the electoral process will become more personalised and trivial as time goes on.

There are lots of things to discuss. Is this basically a great devolving Bill, a liberating Bill for councils and local people, as the Government say, or is it a centralising Bill, acting against devolution and against liberating people, as some of us suspect? As the Bill goes through Committee, we might find the answer to at least one or two of those questions.

Photo of The Bishop of Peterborough The Bishop of Peterborough Bishop 5:12 pm, 20th June 2007

My Lords, as a regular wearer of purple, I hesitate to speak after the remarks of the noble Baroness, Lady Hamwee. However, I am grateful to her for reminding me of our time together in Mortlake, where we developed a model of partnership between church and local government whose fruits are still evident within that community.

The histories of the structure of local government and the church in this country have long been intertwined, and not just by nomenclature. The boundaries of parishes in both church and local government are still coterminous in many rural areas. All of us grapple with the connotation of the word "local". What is "local" in our modern society? Tempting though it is to draw parallels between the changes in local government proposed in this Bill and the changes going on in the church, I will leave comment on that part of the Bill to others.

I, too, want to concentrate on Part 14. I do so because of not just my experience of being a patient and a member of the public, but my contact with the work of the patient and public involvement forums and the work of our local primary care trust and the foundation hospital trust in Peterborough. Indeed, this is an area in which I should probably declare a conjugal interest, as my wife has almost made a second career of involvement with the NHS as, successively, a member of a medical ethics committee, a non-executive director of an area health authority in East Sussex, then of North Peterborough PCT, and now a non-executive member of the board of the new Peterborough Primary Care Trust. In 2004, as North and South Peterborough PCTs in partnership, that was the first PCT to develop a full partnership agreement and pooled budget with the local authority's adult social care service. It recently negotiated a memorandum of understanding with its children's services. That is a model of partnership before LINks existed and certainly before the Bill was published. It suggests that we do not necessarily need a radical change of structure in order to achieve the outcomes of the Bill.

Everyone must recognise the importance of the accountability of those who provide public service. That was reflected in the Department of Health's document A Stronger Local Voice, to which noble Lords have referred. The Health Select Committee's report suggests that there is some ambiguity about the nature of the accountability. It asked whether it is that of a service provider that responds to what people want, the mutual accountability of a partnership or the democratic process of public scrutiny. Speaking as a representative patient, I want the processes of accountability to foster, if not absolutely guarantee, better provision for the health of the whole community—my neighbour's health as well as mine. I also want them to influence the policy decisions that inevitably affect the provision of healthcare.

We hear a lot about patient choice, but administrators and medical staff increasingly face difficult choices in the allocation of precious resources. They do so in the context of a society that wants the latest developments in healthcare to be universally available without always being prepared to spend the extra finance required to bring that into effect. The inevitable result is that there are difficult choices to be addressed about policy and the allocation of finance. Public involvement in health must not only provide feedback, but also create greater understanding of and involvement with the hard choices faced by every doctor, PCT and hospital trust operating with a finite budget. It is against our understanding of accountability that the proposals of the Bill must be judged. I therefore find myself asking whether the provisions of the Bill will provide better feedback and the greater involvement of the public in the policies that inevitably affect patient choice.

I agree with many of the comments made by the noble Lord, Lord Low, and the noble Baroness, Lady Cumberlege. Given the notorious attitudes of some of my predecessors in previous centuries, it is perhaps rash of me to advance the notion that evolution is better than revolution, but I think that it is true in this context. We are presented with the third system of patient and public involvement in fewer than 10 years. As noble Lords know, until the turn of the century, community health councils provided the mainstay of such involvement, but since 2001 we have seen their replacement with patient and public involvement forums supported by the Commission for Patient and Public Involvement in Health. We have also seen the extension of the remit of overview and scrutiny committees to include healthcare, and we now have the proposals in the Bill to replace that system with local involvement networks. I do not think that the Commission for Patient and Public Involvement in Health is alone in thinking that the objectives for increased scope for individuals to be involved in aspects of healthcare,

"could be achieved by amending the existing legislation surrounding PPI Forums rather than legislating for a completely different system".

The present arrangements have not had time to bed down before we are faced with a revolution and a new system. I would prefer to see evolution rather than revolution.

In the consultation process, following the publication of A Stronger Local Voice my PCT expressed its concern in five areas. I hope that the Minister can give it and me reassurance about these matters. First, the forums have both statutory responsibilities and statutory powers supported by a national body. Will the duty on local authorities to establish local involvement networks be equally or more effective in granting these powers and fulfilling these responsibilities? Secondly, unless these powers are granted, will the local networks attract the quality of volunteers who, as the noble Baroness, Lady Cumberlege, reminded us, are able and willing to make a significant difference? The forums' role and structure were clearly defined and attracted members whose experience and knowledge have grown since they joined. As my PCT said, it seems wasteful and counterproductive to start again with a new organisation, with loose and ill defined terms of reference and without the clout to attract and motivate volunteers.

Thirdly, at present the fora set their own agendas, without political or commercial interference. Will the networks be equally independent and free of the risk of undue influence from groups of individuals with a particular agenda of their own? Fourthly, will not the reliance on funding from the local authority rather than independent sources put adequate financial support at risk from political or commercial pressure? Finally, in the light of the Minister's opening remarks, I should value confirmation that the networks will have the key powers of access and response to inquiries to enable them to be as effective as the present arrangements are in monitoring services and processes within health and care organisations.

I recognise that the basic principles of this Bill are unlikely to change, but I hope that we will be able to amend it in Committee. The Minister said in her introduction that the Bill is essentially pragmatic, but I fear that I am yet to be persuaded of the advisability or necessity of the wholesale changes to the existing provision proposed in Part 14. As patients, we need reassurance that the proposed system will provide a better service, with a stronger local voice, as the Government desire. I hope, therefore, that the concerns that my PCT has aired can be allayed in your Lordships' ongoing consideration of the Bill.

Photo of Lord Smith of Leigh Lord Smith of Leigh Labour 5:23 pm, 20th June 2007

My Lords, I begin by declaring my interest as leader of Wigan Council. In that role I do not recognise the negative description of local government that we have heard from several previous speakers in the debate. I would temper the kind of nostalgic reflections or longing for the past with the suggestion that noble Lords read the biography of Herbert Morrison to see what he thought about the role of back-benchers and strong leadership in local authorities.

Most local government that I know in Britain today is confident and is delivering good-quality services for local people and improving performance. Despite their unpopularity, best value and inspection have helped significantly to deliver that, but the Government are right now to reduce the burden of those particular things.

I welcome the Bill because it gives local government the opportunity to continue to flourish. I say that for two main reasons. It is an enabling Bill. It is not prescriptive as many previous local government Bills have been. It allows local authorities to choose which way they want to go within a particular area. In Parts 1, 2 and 3 there is significant choice so I welcome that. Unlike the noble Lord, Lord Greaves, I am confident that it is not a centralising but a devolving Bill. It will give local authorities more power. Local area agreements are key to the Bill; they are at its heart. They will allow us to shape the place, as Sir Michael Lyons said. I shall concentrate my remarks on that part, but before I do so, I shall make three brief comments on other parts of the Bill.

My noble friend Lord Clarke of Hampstead gave an eloquent exposition of the need for unitary authorities. I experienced a metropolitan county system, a two-tier system, and unitary authorities are certainly better. But there is always a danger for local authorities of being hidebound by boundaries. However good the boundaries may seem in a geographical or place sense, issues, problems and people cross those boundaries. In the city region of Manchester, we are beginning to learn, as are other city regions, that we have to work together. If we are to achieve the big changes to our economy, to transport and crime—all the things that we want to achieve across the city region—we will have to collaborate. That is a message for all authorities, whether in a city region or in districts: they must learn to work together better. That will be the future.

My second point is about leadership. The Government are right, as they did in the White Paper, to emphasise the value of strong local leadership. However, I am a bit concerned that the Government—and the Opposition, if we are to believe the media reports of the review of the noble Lord, Lord Heseltine—are putting too much emphasis on structure, on an arrangement, rather than on what leadership is. Leadership and executive arrangements should not be confused. Local leadership is about developing a vision for an area, communicating that vision to others within the council, to local people and to other partners and ensuring that it is implemented. Whereas some executive arrangements may make that easier, you do not get strong, effective leadership just because you change those executive arrangements.

Perhaps Governments think that local government Bills get too boring for those not involved in local government, because in my experience, they always introduce into a local government Bill a clause or a part that is not directly about local government, but excites your Lordships more than others. In my maiden speech in 1999 on what became the Local Government Act 2000, it was the clause to repeal Section 28. I remember that on Second Reading, the majority of the speeches were not on the 99 clauses about local government but on the one clause about Section 28. Perhaps today we are in danger of concentrating overmuch on Part 14 compared to the rest of the Bill. However, I welcome that responsibility coming to local authorities and I thought that the noble Baroness, Lady Campbell, explained the thinking behind it very effectively. I am sure that local authorities will welcome and will be able to organise those arrangements for monitoring the performance of both health and social care. To bring them together is very logical.

In his reflection on his achievement in creating the NHS, Aneurin Bevan admitted to one mistake. That was that he should not have removed local authorities from the healthcare system, as he did in 1948. At least in those clauses the Government are partially rectifying that mistake.

As I said, it is on Part 5 and local area agreements that I want to concentrate my comments today. I think that local area agreements have made a great difference in local authorities and to local people. What local people want is good delivery of a range of services. If we are honest, they do not care who does it. They do not care whether it is staff from social services or health staff who come to deliver a service, as long as it is timely and done well. Local area agreements have allowed local authorities to get involved with a range of areas in which they are not directly involved. With a democratic mandate, we have been able to get involved with a much wider area of things that really matter to people, to their lives and to the places where they live. It is devolution to local authorities. I am pleased that the number of targets essentially is reducing. My authority was a pilot authority for LAAs. It has been a very positive experience, has fostered closer working relationships with a range of partners and has given satisfaction in achieving a range of ambitious targets.

However, we had three difficulties with the LAA. The first difficulty was the approval of the LAA. We had a really constructive relationship with the government office, but when the plans came to Whitehall, the dead hand of the Civil Service unfortunately said that the plans were too innovative and that it did not think that it could do that. It eventually took an intervention from the Minister to overcome that handicap. The Government should approve LAAs because they are important, but we will not use them to stifle innovation or the way in which local areas deliver for local people.

Secondly, the recognition of LAAs across government departments was not always there. That was particularly true for health, which had a range of national targets to deliver. The LAA targets were not always regarded as important. Clause 118 addresses this issue. To bring together the evidence base of what is needed in health and social care is important. When the Secretary of State agrees the LAA, I hope that it is implicit that it is not being signed on behalf of the Department for Communities and Local Government, but that it is being signed on behalf of the Government overall and that each department is signed up to making sure that the LAA is important to it.

The third difficulty is the ability of local partners to divert some of their mainstream resources to LAA targets, which was not always the case in the past. I am pleased to see that the duty on local partners is to have regard to targets. We may want to raise later whether this is strong enough. Perhaps we should have achievement of the targets rather than having to have regard to them, which would give a greater incentive to many of the partners to divert resources and make sure that that happens.

During the passage of the Bill through another place, the Government listened to representations and in Clause 106 broadened the list of organisations to be partners to local authorities. However, despite the improvement, the list is incomplete. I cannot believe—certainly, it will not happen in my area—that the local area agreement will not have targets for education, achievement, participation, life-long learning and so on. If we are to achieve these things, we need to bring along those who will deliver those targets in the local area, but no examples of local colleges are on thelist. In most cases, local colleges are good, strong partners and willing participants. I do not believethat there should be any problem in including local colleges.

I understand the Government's reluctance in relation to schools, partly because the number of schools makes them problematic. But schools should be at the heart of local communities and should be involved in setting and delivering targets. I hope that the Government will think about that. I do not think that it is satisfactory to allow schools simply a voluntary process of involvement in the LAA process. The problem is that those schools which are least likely to get involved are the ones that probably most ought to do so. I hope that my noble friends will think about how we can have further discussions with the Department for Education and Skills on how to get schools involved, even if we do not have to name every school as a partner on the list.

While I look forward to the detailed scrutiny of the Bill in your Lordships' House—I am sure that we will find ways of improving it—we should accept its Second Reading with a positive view. It is a good Bill, it may be improved, but I welcome it.

Photo of Earl Howe Earl Howe Shadow Minister, Health 5:35 pm, 20th June 2007

My Lords, Part 14 of the Bill deals with patient and public involvement in health and social care. In thanking the noble Baroness, Lady Morgan, for presenting the proposals foreshadowed last year in A Stronger Local Voice, I am sure we all wish the noble Baroness, Lady Andrews, a stronger ministerial voice in very short order.

It seems like only the other day—in truth it really was only the other day—that we debated long and hard the Bill which created patients' forums in place of community health councils and simultaneously set up the Commission for Patient and Public Involvement in Health. I venture to think that the Minister who took that Bill through this House, none other than the greatly respected noble Lord currently sitting opposite me, the noble Lord, Lord Hunt of Kings Heath, would have described its passing as hard fought for and hard won. It is therefore well nigh incredible that we should be debating yet another complete transmogrification of patient and public involvement in healthcare; not a set of evolutionary amendments to the present structure, but wholesale organisational change. I remember the noble Lord, Lord Hunt, telling your Lordships in 2002 at the conclusion of the Bill's passage that this,

"is as good as it gets".—[Official Report, 13/6/02; col. 419.]

It was only a few years ago that the noble Lord, Lord Warner, told us that patients' forums would remain,

"the cornerstone of the arrangements we have put in place to create opportunities for patients and the public to influence health services. We are completely committed to those forums".—[Hansard, 5/7/04; col. 516.]

Honestly, what are we meant to believe?

Patients' forums have been going for about four years and they are making their presence felt, in many cases quite effectively. The Government now want to abolish them. The obvious fear I have is that this will achieve the very thing Ministers say they do not want to happen, which is to make patients' forum members feel so demoralised that they just want to give up in despair and go home. We saw exactly that when CHCs were abolished. Many of the people with real expertise and who had committed themselves for years to making patient and public involvement a living reality threw in the towel. The noble Lord, Lord Hunt, always assured us that the Government did not want this to happen, but it did so nevertheless, and it is going to happen again. If the Government really mean it when they say that they want to strengthen public involvement in healthcare through these new arrangements, the one thing they can do now is to convey to patients' forum members that they are needed, wanted and valued both today and for the longer term. So far, frankly, I do not see much sign of this. No patients' forum member sat on the expert panel that reported to Ministers last year. In the whole process leading up to the publication of this Bill, patients' forum members have been sidelined and ignored. So if I were a member of a patients' forum, it would stretch my credulity to be told that actually I had an important part to play in making the proposed new structures work effectively.

What are the new structures? The Bill gives us no clue whatever. Local involvement networks are not described, or at least they are described only by reference to what they are not. We are told that the Government do not want to be prescriptive and that it will be up to each LINk to set itself up in the way it wants. In Greek legend, I think it was Proteus who was able to assume any shape or form that he liked. The reason why he did this was in order to avoid foretelling the future. For us debating this part of the Bill, it is almost impossible to foretell the future because neither the governance arrangements of LINks, nor their structures, nor their powers, nor even the precise scope of their activities, are set out here. In a real sense, as with Proteus, we do not know who or what we are dealing with.

As I understand it—the Minister may correct me—because LINks are not defined they are not classifiable as statutory bodies. We may know a LINk when we see it—although I am not completely sure about that—by virtue of the things that it does. The Bill refers to activities being "carried on". In fact, in one way or another, there is quite a lot of carrying on in this part of the Bill. There may be a joke there somewhere but I shall refrain from trying to find it. But that nebulous form of drafting is as far as we get. It will be incumbent on us in Committee to try to flesh out some of this unsatisfactory vagueness.

That brings me on to something fundamental: what we are meant to understand by the term "patient and public involvement". Involvement can amount to a little or a lot, but it cannot, surely, count for a great deal unless patients and the public are able to exercise some real influence on the commissioning or provision of local services. The main problem with the Bill is that because LINks have no identity or definition, they can be seen neither as bodies whose independence is guaranteed, nor as bodies which have the power to hold local health and social care commissions to account.

Such powers and duties as there are in the Bill are vested mostly in providers and commissioners rather than with the LINks themselves. That, in my view, is a retrograde step. We need to remember what led to the Government reforming patient and public involvement in healthcare six or seven years ago. One of the 198 recommendations of the inquiry into children's deaths at Bristol Royal Infirmary was this:

"The involvement of the public in the NHS must be embedded in its structures: the perspectives of patients and of the public must be heard and taken into account wherever decisions affecting the provision of healthcare are made".

The sad events at Bristol showed that accountability of the NHS to patients can be poor. There is surely no case for weakening that accountability. Accountability has to be, as the Bristol report stated, embedded in NHS structures, yet this Bill takes us away in diametrically the opposite direction from that aspiration.

The way in which the Bill is worded does not give the impression that the Government are seriously committed to the NHS developing as a patient-centred service. To be a patient-centred service means a system in which patients and the public can participate nationally and locally in setting and reviewing standards and monitoring the way in which those standards are observed. I challenge the Minister to show me how the Bill gives LINks any real power, real leverage, to influence commissioning decisions. Instead, what we are being asked to approve is a weakening of the powers contained in Section 11 of the Health and Social Care Act 2001. Under that section, local communities have a right to be involved in and consulted on the planning and provision of services and proposals for change. Clause 232 of the Bill removes the word "involved" and keeps merely the word "consulted". Being consulted on plans that may already have been formulated is a very different thing from being involved from the outset in shaping and developing those plans.

On proposals for change in health and social care services, Clause 232 would restrict the right of consultation to changes that are significant. What counts as significant is again far from clear, but we are looking at a dilution of influence on the part of the citizen. On the provision of services, we are told by Ministers that LINks members will be held at arm's length from the most vulnerable service users of all, including children and those with learning disabilities—the very people whose interests need promoting and safeguarding.

To monitor services properly, you need to talk to patients and staff and have the freedom to enter premises as of right. LINks will not be able to carry out unannounced spot visits. To say that that is the job of the regulator misses the point that neither the Healthcare Commission nor CSCI is able to visit any given set of premises on anything other than an infrequent basis. They are not resourced to do so. Inspectorates may be able to oversee governance arrangements perfectly adequately, but they cannot hope to monitor services. There is a big difference. When LINks have comments and recommendations to make, they should be able to make them to any appropriate body, not simply those listed in Clause 222. If they are not seen locally to have teeth and real influence, not only will they lose credibility but they will find it hard to drum up people to lead them.

Part 14 of the Bill does not pass the key test that was set by both the Bristol inquiry and by Derek Wanless in 2001, who saw patient and public involvement in healthcare as essential for the delivery of what he termed the "fully engaged scenario". That scenario, let us remind ourselves, was viewed as essential to the long-term sustainability of the NHS.

We see in the Bill the Department of Health divesting itself of responsibility for delivering patient and public involvement and health and social care, and indeed getting as far away from it as it possibly can. I shall not speculate on the real reasons for that; noble Lords can perhaps do so for themselves. Whatever the reasons, we should be sorry that this is a path that the Government have chosen to take.

Photo of Lord Mawson Lord Mawson Crossbench 5:47 pm, 20th June 2007

My Lords, as I rise to make my maiden speech I am conscious, as the son of a milkman from Bradford, of both the privilege and the responsibility of taking a seat in this place. I take this opportunity to thank those noble Lords and staff who in the past few weeks have helped me to feel so welcome, particularly the noble Lord, Lord Rogers of Riverside, and the noble Baroness, Lady Cumberlege, who supported me at my introduction. I also thank the noble Lord, Lord Williamson of Horton, and the noble Baroness, Lady D'Souza, for helping me feel at home on the Cross Benches.

I am one of those strange creatures some have come to call a social entrepreneur. I have spent nearly 25 years working in the middle of a group of run-down housing estates in the East End of London, attempting to improve the quality of people's lives and to encourage local people, for so long dependent upon the state for virtually every aspect of their lives, to take some personal responsibility for their local area and their own futures. We have had some success.

When I first arrived in Bromley-by-Bow as a young clergyman on a cold November evening in 1983, I was greeted by 12 elderly people in a 200-seater church, sitting where they had always sat. It looked as though the dead had been carried out and no one had noticed. I soon realised the seriousness of my predicament. Everything was run by the state. There were virtually no businesses and absolutely no private housing, and many of the public services and structures of local government and health did not work at all well for members of my local community. You felt you needed permission from five government agencies to blow your nose. I was surrounded by people who spoke 55 different languages and dialects and were living cheek by jowl within 10 minutes' walk of our church buildings.

It was soon clear to me that there was no quick fix. To understand the real impact on local people's lives of these realities, it would be about the long game. It would not be about seemingly endless three-year initiatives, mostly delivered by people who had no real connection to the community they were tasked to help. It would be about watching and engaging with the effects upon people's lives of 18 different structures of the health service that have passed our doors over the years, countless reorganisations of local government and senior staff who have come and gone, many of them good people, as they have attempted to make countless local government structures work. Strangely, the realities on the ground seemed immune to this frenzy of organisation.

It has been my and my family's privilege to live and work with many East End families and individuals who have shown great resilience and enterprise when up against such a merry-go-round. I have watched individuals become active, responsible citizens not just by sitting on committees but by rolling up their sleeves and taking over, shaping places and delivering services in practical, entrepreneurial ways.

During my many years in east London, I have operated 200 yards from what is now the 2012 Olympic site, of which I will have more to say later, particularly with regard to legacy. I have danced with many dinosaurs and had my feet trodden on more than once. It is from this background that I make the following general points about the Bill.

First, one of the Bill's key themes is the Government's desire to reform local government so that it is very clear where local leadership lies and to encourage personal responsibility to be taken by clearly identified individuals. I welcome this approach. It is my experience on the ground that such an approach leads to a more effective delivery of public services. People want to know clearly who is leading them.

Secondly, in east London, we have enjoyed, or suffered—depending upon your point of view—the complexity of being a pathfinder for every structural change successive Governments have invented. Therefore, I welcome the Bill's second important theme—to foster the integration of public services under a common strategy with common leadership.

I begin to have difficulty with the Bill on its third major theme of empowering citizens and communities. This is what a great deal of my work has been about. The practical experience of working in disadvantaged communities through the work of the Bromley by Bow Centre, where I have an interest, is that many people are not particularly interested in engaging with yet more committees and forums. Actually, the key to greater public involvement is to help people get practically engaged in helping them to create change for themselves. Billy Canon was a man on our estate with a difficult life experience, which left him on the edge, leading to poor health. He became an active healthy citizen because he was given the opportunity to take part in designing, building and then running a local park in a hands-on and practical way.

When in the early 1990s we proposed that we—at that time, a small community organisation—would build a new health centre, showing that primary care could be delivered in a better way, you would have thought that it was a nuclear missile site we were developing, judging from the reaction of the statutory authorities. We persevered and we delivered. We proved that you did not have to have grilles to protect staff; that you could integrate a primary care team with community and voluntary staff; and that you could run and maintain high quality creative facilities full of art, rather than sterile spaces full of plastic chairs smelling of disinfectant.

We challenged the often unwritten and unspoken assumptions about the quality of care and facilities that can be created and delivered without breaking the bank. We tweaked the nose of local statutory bodies and, to be fair to them, many are now working closely with us. They have raised the bar on what they consider should be the quality of services that are delivered.

The health centre that we run and the social housing company with which I am associated have both won a number of awards from government, and are recognised for their practical, hands-on community empowerment. While I am most proud of the lives that that have been improved directly, many more lives have been improved by raising the expectations of health providers and planners who have visited the Bromley By Bow Centre and seen what can be achieved and sustained.

However, this thinking needs to be reflected in the Bill. Social entrepreneurs are finding new and effective ways to deliver public services on the ground, and it would be wise to learn from their experience. It is not clear that the proposed local involvement networks as set out in the Bill are likely to lead to substantial change unless there is a significantly different approach. I hear that quite a lot more detailed work needs to be done on thinking through what the networks will do and how they will work in practice. In this regard, I was encouraged by what the noble Baroness, Lady Campbell of Surbiton, said today.

I ask Her Majesty's Government to consider amending the activities of the local involvement networks clearly to include the task of recommending those services which might be more effectively delivered by social enterprises than by statutory bodies. Given the focus of the Bill, I have in mind in particular those services that overlap existing statutory boundaries—for example, health, care and education—and which as a result often create difficulties in delivering joined-up provision.

What I would like to achieve in your Lordships' House is to champion the simple idea of allowing people who want to take a direct role in the delivery of services to do so, rather than assuming that it is always the state that must deliver for them.

During my years in east London, I have been continually impressed by the support of Members and colleagues from this House—Lord Peyton and Lord Ennals come immediately to mind. The suggestion, as some have made, that Members of this House are in some way disconnected from the realities of the world in which I have lived, I have not found to be true. These people's moral fibre, sheer practicality and friendship have been a great source of strength to me and my colleagues over the years, and I shall do my best in my time here to add to their reputations. Unlike some Members of the other place who came and went, Members of this House have been steadfast in their support. In fact, Members of your Lordships' House have provided an advocacy role, enabling a small and growing neighbourhood organisation to have access to the Executive, and have enabled lessons from a local setting to enrich national policy.

Photo of Baroness Jones of Whitchurch Baroness Jones of Whitchurch Labour 5:58 pm, 20th June 2007

My Lords, it gives me great pleasure to congratulate the noble Lord, Lord Mawson, on such a knowledgeable and impassioned maiden speech. He brings to this House experience steeped in the very best social and community action and, as we have heard today, with a very simple but strong message. I know from my time as a union official in London of the excellent work of the east London churches in uniting diverse communities and strengthening tolerance across the faiths, of which he has been a part. The noble Lord very ably demonstrated today his capacity to bring a fresh perspective and unique insights to the work of this House. I know that I speak for everyone when I say that we will be eager to hear his contributions in future debates.

I am pleased to have the opportunity to speak in this debate. In doing so, I am aware that the principles and details of the Bill have already been subject to considerable debate. I shall therefore endeavour not to repeat the arguments that have already been made, but concentrate instead on one or two general and specific areas that concern me. I say at the outset, however, that I welcome the broad thrust of the Bill. On the one hand it brings some welcome clarity and simplicity to local government structures; on the other, it takes some small steps on the road to political re-engagement with citizens and communities.

The new freedoms for local authorities which underpin the Bill have been a long time coming, some might say too long, and they have been hard-earned. There is no doubt that councils have been transformed over the past 10 years. They have become efficient and responsive service providers and should quite rightly take pride in the plaudits heaped on them by their external assessors such as the Audit Commission and the inspectorates. But there is one area where arguably they have been less successful, and it is an area where, to my mind, the Bill could have had greater boldness and vision and to which I would like to focus some of my comments today.

It is now widely acknowledged that we are facing a crisis of faith in our political systems. There is an urgent need to inject new energy and enthusiasm into our representative democracy. I suspect that we would all agree that the impetus for this has to start locally, reconnecting individual citizens and their community organisations. The statistics speak for themselves in terms of lower electoral turnouts at local and national elections. I cannot help feeling that, despite the progress in other areas, local government could have done more to play its part in addressing this crucial challenge. While I acknowledge that the Bill contains measures to strengthen community involvement, I remain concerned that it will be too little too late to hold back the tide of political apathy. This is where I agree with so much of the analysis of the noble Lord, Lord Mawson, about the steps necessary to build involvement in the community.

I was pleased to hear that there had been considerable dialogue with the LGA in drafting the Bill. I have always had considerable respect for that organisation, a point which I emphasise in the knowledge that I am being followed in the debate by the noble Lord, Lord Bruce-Lockhart, who I know will have strong views on this matter. I run the risk of sailing close to the wind on this.

For many years I chaired the Labour Party's local government committee and worked closely with a number of our local government leaders, and I continue to hold them in very high regard. I hope they will not mind it too much if I say that my abiding memory of my interface with local government across the political spectrum was of endless debates about structures, rules and procedures, which always seemed to take precedence over concerns for greater citizen empowerment. Unfortunately, in reading the Bill, it still feels that that balance is eluding us.

The Minister has pointed out the Bill's excellent measures. I fully acknowledge and welcome the strengthened role for ward councillors, the concept of the community call for action and the potential for more funding for local community projects. There is no doubt that those and other measures in the Bill will give citizens and communities a stronger voice. But I remain concerned that the Bill has a contradiction, or at least an imbalance, between strong and decisive leadership and giving citizens more of a say over their services—which inevitably is more messy, time-consuming and sometimes unpredictable. If we are not careful about getting the balance right the voice of the citizen and the community will not find its proper place in our measures.

I have a simple test for proposals such as these: what would be the reaction of young people—who, after all, are the next generation of community leaders—if they were shown the key proposals in the Bill? Would they be enthused? I could, for example, imagine that young people could be persuaded of the merits of the community call for action; it certainly implies a simple and immediate response. My guess is that they would be less impressed if they heard that the ultimate sanction for community calls for action is to refer the issue to the overview and scrutiny committee. To make young people feel that they can influence their world, and to re-engage them in the political process, requires a rethink of our language, communication, mechanics and understanding of the role of accountability. We are all trying to reach out across the expanding political chasm. I would have liked the Bill to do more to heal that divide. I hope the Minister is able to point me towards proposals that might do that in the future.

I have concentrated so far on the Bill's broad objectives but there is also a specific issue of concern that I wish to raise today. In this context I should declare an interest as a member of Unison's parliamentary group. I very much welcome the Bill's proposals to extend and formalise local area agreements, which have the potential to become powerful tools for transforming local services. I equally welcome the duty for named partners and the local authority to co-operate and agree targets within the local area agreement. I know that there has already been pressure to add to the list of named partners, and of course the more you add to the list the more you downgrade the groups that are not explicitly mentioned; but there is one group that I feel deserves explicit mention over the others, and that is the workforce, who after all are crucial to the effective delivery of any agreements made.

The proposed change in the Bill from single to multi-agency planning will have the effect of making the current staff consultation arrangements obsolete. There is already an obligation in the information and consultation regulations 2005 for individual employers to consult their staff, and all the social partners are signed up to that. However, under the new local area agreement provisions the key decisions will be taken by the partners, which currently exclude trade unions, and then the council will consult further down the line, making the consultation meaningless as it will present the staff with a fait accompli. So, to maintain the current levels of consultation, it is essential that there is a requirement for recognised trade unions—that is, the voice of the workforce—to be consulted when local area agreements are formulated. This should not be left to individual councils to interpret on a case-by-case basis. I hope that the Minister will be prepared to consider wording to make that explicit.

I said at the outset that the Bill is a welcome initiative, and I want to reinforce that view. Having spoken to many people in local government both working and providing the services, I know that the Bill has broad support. I hope that we are able to assist its passage through this House in that spirit.

Photo of Lord Bruce-Lockhart Lord Bruce-Lockhart Conservative 6:07 pm, 20th June 2007

My Lords, first, I congratulate the noble Lord, Lord Mawson. I am sure that your Lordships' House will benefit greatly from his experience, knowledge and passion for social enterprise and social issues. I also congratulate the noble Baroness, Lady Campbell, on an inspiring speech. I must declare my interest, perhaps for the last time, as chairman of the Local Government Association.

I believe that the Bill should be judged in the context of considering the major issues facing local government, understanding the potential for local government to meet those issues and challenges and asking what is impeding local government in its progress, how the Bill can help to release the potential and, as others have said, how that will affect people's lives.

Speaking after the noble Baroness, Lady Jones, I am relieved that I am not starting off with structure. I shall concentrate first on the perhaps four major issues that we in local government face. The first, as everyone is aware, is simply the challenge of improving public services, achieving better value for the public's money, ensuring quality, extending choice and opportunity, raising public satisfaction, extending access, responding to public demand and tailoring our services to what the public actually want.

The second is the need to strengthen economic prosperity, to address the backlog in housing, transport and regeneration, and to create places that are prosperous, vibrant, friendly and safe—places with a sense of identity and belonging where people are proud to live.

Thirdly, apart from core public service improvements and economic issues, there are wider, more complex challenges for society, ranging all the way from climate change to health improvement. For example, it is simply tragic that after more than a decade with the luxury of a strong economy, many of the social divisions in society are widening. The affluent are becoming more affluent, but the 20 per cent or so who are least well off are today worse off. They often live in disadvantaged communities with high rates of crime and disorder, a high level of teenage pregnancy, high incidence of drug use, poor health and high worklessness. They are trapped in welfare dependency and have low skills and aspirations.

These issues are highly complex and interrelated, but two things are certain: they are best tackled in partnerships and they are best tackled locally. Therefore, I welcome the Bill's strengthening of local area agreements and council-led local area agreement boards involving the public sector, the voluntary sector—the social enterprise mentioned by the noble Lord, Lord Mawson—the community sector and the private sector. This is the way forward. The duty to co-operate is helpful, but we shall want to return to these issues during the Bill's passage to make sure that it can release the full potential of local area agreements. This is a challenge for local authorities.

The fourth issue, to build again on what the noble Baroness, Lady Jones, said, concerns trust and democracy. In recent years there has been growing cynicism about and a lack of trust in politics and politicians. Too often politicians are seen as not relevant to people's daily lives, their worries, hopes and aspirations for the future. Yet those issues are immensely important to people—their services, community, local hospital, local school, local park and the safety of their streets. People are deeply frustrated by their inability to reach remote and, indeed, unreachable systems of governance. Therefore, we have to take government closer to people on the ground and strengthen local democracy.

In each of these four major objectives we see improvement being held back by a common factor—the overcentralisation of the state. I have made my next point before and I am sure that, unfortunately, I shall do so again; namely, that this country is unique in the degree of control that our Government exert over public services and local government. This overwhelming burden of bureaucracy, plans, guidance, targets, performance indicators, financial controls and inspection systems wastes the public's money. It stifles the enterprise and commitment of front-line staff and denies councils the ability to take local decisions, responding to what local people want. In doing so, it weakens accountability and erodes democracy. Therefore, I do not agree with what was said in the first speech—that there is a strong devolutionary element in the Bill. What we need is bold devolution.

Local government is not easy but it has made great progress. It now has an outstanding track record of improvement. The Treasury says that it is leading the public sector on efficiency. Local government is determined to build on this improvement and make a real difference to people's lives. Last year, the Local Government Association published its paper Closer to People and Places, in which it set out specific steps, some of which are in the Bill—that is to be welcomed—and some of which the Bill has failed to address.

The local government White Paper set out important steps on deregulation. This followed much joint working between the Government and the Local Government Association. We argued for the reduction of the 1,000 performance indicators down to some 30 national outcomes and for no more than 200 performance indicators. That is welcome, but it needs to be accompanied by a reduction in all central controls. It is essential that this happens in practice. We shall need to return to this issue in Committee.

At the same time, the local government Bill has made real progress in strengthening council leadership, but we need to look at the scrutiny issues. I welcome the electoral cycle changes. I welcome what I believe is a restoration of the right of councillors to speak on all issues affecting their constituencies. But the Local Government Association believes that all councils should have discretion in their choice of executive arrangements.

The Bill makes very little progress on devolution. Coming back to the second challenge of economic prosperity, the Treasury's document Devolving Decision Making shows clearly that the great cities of England—Birmingham, Manchester, Liverpool, Sheffield and Newcastle—now have just half the GDP per head of their European counterparts. The Treasury report concluded that one of the reasons for that is that the European cities have far stronger devolved political autonomy, as the noble Baroness, Lady Hanham, said, over the key economic levers of planning, transport and economic development. The Local Government Association therefore proposed in its publication Prosperous Communities a radical devolution in planning, transport, housing, economic development, skills and welfare from regional and national government to local authorities.

The Chancellor of the Exchequer has not said a great deal about local government. He has talked about a new constitutional settlement, but in September last year he said:

"It is right that local councils, not Whitehall, should have more power over the things that matter to their community, and from economic regeneration to public transport, the empowerment and strengthening of local councils and local communities is what we must now do".

When the Chancellor becomes Prime Minister in a week or so, we shall look forward to hearing about the detail of how he will take this forward. But how will the devolution of powers be brought into the Bill? Will it be through local area agreements? We need to test this.

Any meaningful devolution must include funding as well as powers. It seems that after five years of the Government reviewing this, the issue has been ducked. Yet local council tax payers need a system of local government finance which is fair, understandable and transparent, and which retains more of the taxes that are already raised locally. They need a system in which councils can respond to local priorities and in which the accountability for council tax rises is entirely clear. The Local Government Association has argued for an independent commission to oversee the local government finance system, its distribution and equalisation, the incorporation of the latest population and demographic changes and, most important of all, the introduction of a watertight "new burdens system" to ensure that the cost of the Government's new policies and legislation are borne by the relevant spending departments and not by council tax payers.

I was not going to dwell on finance, and I will conclude. I did not like the reference to a 39 per cent increase in local government funding over the past decade. That includes the direct schools grant. As the noble Baroness, Lady Andrews, will know, I have made that point before. It is entirely clear that the figure is 14 per cent. Before he stood down, the Deputy Prime Minister understood that you cannot include the direct schools grant, which leaves you with 14 per cent and not 39 per cent.

In conclusion, devolution, deregulation, the strengthening of local leadership and local partnerships, and accountability need to be at the heart of any reform of local government. We look forward to testing those during the passage of the Bill.

Photo of Baroness Masham of Ilton Baroness Masham of Ilton Crossbench 6:20 pm, 20th June 2007

My Lords, I cannot resist congratulating my two noble friends on their splendid and humane maiden speeches. It is because of my interest and involvement in health that I am speaking in this debate. The noble Lord, Lord Hunt of Kings Heath, at one time was the secretary of a community health council, and I was a member of one. This is going back many years, but I clearly remember that it was the members who were representing the county council who were not the best attenders at CHC activities. As county council members they had many meetings, and health did not seem to be their highest priority.

When the health reforms were taking place and CHCs were being replaced by health forums, the noble Earl, Lord Howe, and I, among others, were keen to build on CHCs and make them better instead of having to disband them and set up forums in their place, which we thought would not be as independent. The noble Lord, Lord Hunt, spoke very much in favour of health forums so, with the help of the Commission for Patient and Public Involvement in Health, patient and public involvement forums were set up. CHCs, which had existed for 28 years, were abolished in December 2003 to make way for the new system of patient and public involvement, which includes the establishment of the PPI forums and other committees. The CPPIH then established 572 forums; one for every NHS hospital trust, primary healthcare trust, ambulance trust and mental health trust. It recruited approximately 5,000 volunteer members of the public to serve on them. PPI forums monitor and review services provided by the National Health Service and report on matters of public concern and make recommendations for improvements.

During the past months, I have attended two meetings for members of patient forums from all parts of the country, which were chaired by Patrick Hall, Member of Parliament for Bedford. He also is a past member of a community health council, and he and I serve on the Associate Parliamentary Health Group. In all my years in your Lordships' House, I have never witnessed such a disgruntled group of people who feel utterly let down as those forum members. I thought that Patrick Hall did very well to keep such a ferocious gathering under control but at the same time enabling them to voice their frustrations. He gave me permission to mention that. I can understand the feelings of the health forum members, who have had to cope with the changes in the primary healthcare trusts during their first three years. Now to be disbanded seems a waste of everyone's time and training and taxpayers' money. They have specific legal powers to inspect services, request information from NHS trusts and refer matters of concern to other appropriate bodies, particularly local authority overview and scrutiny committees.

In March, the House of Commons Health Select Committee produced a report on patient and public involvement. The committee expressed serious doubts about the Government's proposals. It said that the evidence points to developing the existing system rather than starting again. That is what some of us said about CHCs. The Department of Health's proposals are vague and woolly, as has already been stated today. The committee was concerned about social care providers acting as hosts because of the risk of conflict of interest. Who will be the hosts? Where will they be housed? Lines of accountability are confused. Will trial LINks offer a better picture of how LINks will operate, or will they all be different? The lack of clarity about the role and structure of LINks is likely to create confusion and inactivity. The committee was not convinced that abolishing the CPPIH would release significantly more funding to the front line. LINks will be asked to carry out more work than PPI forums, with no guarantee that the necessary resources will be available.

The Department of Health has recently responded to the Select Committee's concerns, so I expect that the Minister will respond to them in his winding-up speech. I see the value of the NHS and social services working more closely together, but the NHS alone has so much for patient representatives to concern themselves with, such as: hospital bedside entertainment services; telephones; hospital food and feeding; the need for volunteers; dignity and privacy; mental health facilities; maternity services; the needs of disabled patients; hospital hygiene—the fear of catching a hospital infection is very much in patients' minds when they have to go into hospital—haematology services; patient safety; out-of-hours cover and disabled equipment in the community. The list is very long and it goes on. What about prison health and aftercare? Is that something that LINks should get involved with? It is now part of the NHS. If the facilities provided by social services are added to the NHS, might not the LINks fall between the two?

It concerns me that LINks members are not going to be able to inspect premises directly, as the noble Earl, Lord Howe, said. I will now relate something that happened a few years ago. Out of the blue, I received a letter from a lady in Leeds who was in a care home. She wrote that on paper there were trained staff, but very often there were not. She was in a room with an alcoholic. She had her letters censored, and when she wrote to me a friend had to smuggle the letters out. She was unhappy and wanted to change homes. I contacted someone who I knew on the area health authority who had contacts. Some time later, I received another letter from the lady. She had been moved to a home in Harrogate. The day she arrived was her birthday, and they gave her a cake. She wrote that the move was like leaving hell and arriving in heaven.

After the "Panorama" programmes this year on care homes, surely there should be spot checks on the dignity and safety of residents. Without seeing what goes on first hand, how will LINks members be able to write realistic reports? For the Secretary of State to make regulations to require service providers to allow LINks to inspect and observe their premises and activities seems like a delaying tactic, and it is very bureaucratic. It seems wrong that patients at risk must rely on undercover members of the press to expose some of the bad things that can happen. The NHS is so important and so many people who have benefited from it are grateful, but many people worry that there is fragmentation and too much bureaucracy. They would like a clear, quick route to have complaints heard expeditiously. The public want a body that will support their requirements and aim towards excellence; but, above all, it should be independent and not dominated by management. Good communication and patient safety should be paramount if satisfaction is to be achieved.

The Royal College of Nursing is particularly concerned about Part 14 and Clause 232, regarding the duty to consult users of health services. The college fears that the dilution of the language in this part of the Bill will lead to great confusion among professionals about when the duty to consult is or is not appropriate. The use of the words "significant" and "substantial impact" is meaningless to nurses and patients. How big is significant? How small is substantial? Who decides what is significant? As there is currently no clear definition of when consultation should be triggered, the RCN fears that judicial review may be required to achieve clarity for patients and nurses. My grandfather-in-law, the first Earl of Swinton, a very experienced politician and lawyer, who was in your Lordships' House when I came into it in 1970, told me that in legislation there should always be a clear definition.

I end on a different topic, but one that I consider to be therapeutic and beneficial for the health and well-being of many people. I am a member of the All-Party Parliamentary Group for Gardening and Horticulture, and it has been suggested to me that there is a strong wish to extend the opening hours of garden centres on Sundays. I do not believe that it is possible to understate the benefits that garden centres, supporting this most popular and widespread of British pastimes, can offer. Sadly, the ability of tens of thousands of gardeners to shape their weekend gardening activities around their schedule is severely limited because all garden centres with more than280 square metres of covered selling space are limited to a mere six hours of continuous trading between10 am and 6 pm, as a result of the Sunday Trading Act 1994. In the peak of the planting season, they are denied any access to garden centres on Easter Sunday.

This Bill presents a timely opportunity to move away from the current settlement of uniform Sunday trading hours imposed on large garden centres towards a model whereby decisions over opening times are devolved to local authorities. A far more fair and flexible settlement, which is relevant to local feeling regarding large garden centre trading, could be achieved by adding a resolution permitting large garden centres to open for longer hours than at present on Sundays and to allow opening on the peak demand of Easter Sunday, if, for example, the licensing committee rules in favour following a community consultation. This flexible approach is warranted because garden centres offer a much wider range of choice of service and public benefit than most other large retail leisure stores covered by the Sunday Trading Act restrictions, as they provide not only plants but facilities and free expert advice pertaining to garden design and may also very well showcase best practice techniques and exemplars that are free to public viewing. Thus an outing to a garden centre on a Sunday provides not only access to quality goods and services but offers a whole-person experience of time well spent, doing something enjoyable, healthy and creative.

I put this suggestion forward for your Lordships' consideration and look forward to the Minister's reply, as I know that he is a very keen gardener.

Photo of Lord Best Lord Best Crossbench 6:35 pm, 20th June 2007

My Lords, I, too, congratulate my two new colleagues, the noble Baroness, Lady Campbell, and the noble Lord, Lord Mawson, on their excellent maiden speeches.

I declare my interest as the president of the Local Government Association and as past and present chair, trustee and chief executive of a number of voluntary sector bodies.

From both the local government perspective and that of the voluntary and community sector, I welcome this Bill as a significant first step down the road of decentralisation, deregulation and devolution. The Bill marks the moment when the pendulum of centralisation starts to swing back. After one-quarter of a century of central government gathering more powers to themselves and sometimes delegating them to independent quangos that it creates, this Bill is the point at which the trend starts tentatively to be reversed.

A decade ago, the Joseph Rowntree Foundation concluded a major programme of research and development on the theme of relations between local and central government. The work culminated in a so-called summit at Leeds Castle in 1996, with six Permanent Secretaries, three Government Ministers and a host of key local government figures. Over a period of two days, the case was well argued for clarity on the respective roles of the two democratically elected layers of UK governance, central and local, and for the central state to stand back from accumulating more and more decision-making unto itself. However, there were powerful reasons why this Joseph Rowntree foundation programme was, despite the millions spent analysing the issues, entirely unsuccessful in influencing the collective mind of Westminster and Whitehall and achieving change. I shall spell out the reasons for that failure of 10 or 11 years ago.

First, senior civil servants in 1996 were deeply distrustful of the competence of local authority management, with some justification in some places. After 50 years of the welfare state and little reform in many areas, bureaucracy, complacency and insensitivity could be found in a number of authorities. Those civil servants in Whitehall held a very different view of their own abilities and in terms of education and intellect I found generally that they did have the edge. Their distrust of local government management led constantly to their advice to Ministers not to put their faith in local authorities to deliver any of the Government's policies.

Secondly, the political divide between left and right in 1996 had been particularly wide for many years. With the Conservatives in power centrally and Labour very strong locally, the mistrust in Whitehall was reflected and reinforced in Westminster. Local councillors were seen not only as incompetent but as the enemies of change.

Thirdly, the voice of local government was confused and weakened by divisions in the sector between the Association of County Councils, the Association of Metropolitan Authorities and the Association of District Councils. It was easy for central government to divide and rule.

More than a decade later, local and central government relations are in a different place. First, at the managerial level there have been remarkable but largely unremarked improvements in quality and standards. Of course, change has not been uniform and some authorities are very much better at managing their affairs than others, but now I do not believe that there are any basket cases of authorities that cannot be trusted with public funds and are likely to ruin the reputation of the whole. The sticks and carrots of an energetic improvement agenda—from the naming and shaming in comprehensive performance assessments by the Audit Commission to sophisticated mentoring and peer reviews through the Improvement and Development Agency, the IDeA—have helped to transform the managerial competence of the sector. I fear that few Whitehall civil servants—admittedly, battered by the welter of ministerial policy initiatives—would claim today that their micro-management can achieve better results than working through their counterparts at local government level.

Although the public and the news media decry the postcode lottery of differences in services between local areas, a new report from the independent Office for Public Management points to the sterility of this debate: whether it is immigration and social cohesion or housing, social care or crime, different places have different demands and require local strategies and priorities. National one-size-fits-all edicts with rigid performance measurements are now thoroughly discredited. We now know that joined-up delivery of different services cannot possibly be organised by central government departments. I think that all parties now agree that it is only at the local level that the strands can be brought together.

Secondly, political and policy differences today are no longer so polarised. On the theme of devolution, there is broad consensus across the parties—with the Liberal Democrats continuing their strong line on this—that central government should loosen their grip. There will always be the temptation for the ever-changing group of government Ministers, of whatever political persuasion, to keep hold of the reins for a policy they believe they have invented, or at least have championed to the point of securing public funds. But it is now all too obvious that implementation—delivery of policies on the ground—cannot be done by the central state. Ministers and civil servants must back off and allow local flexibility to adapt the policy and local ownership to motivate the local members and workforce.

At the same time, locally elected leaders—by no means confined to elected mayors—have been demonstrating real leadership. After the demoralisation of decades of seeing their powers and status diminished, new efforts are certainly required to attract the back-bench councillors who can speak competently and sensitively for their local communities. A new report from the Local Government Information Unit for the All-Party Parliamentary Group on Local Government will be launched this month. It will look at supporting the recruitment, development and retention of a diverse range of local talent as councillors.

Thirdly, local government, impressively, now speaks with one voice, despite the varied structures and politics at the local level. The Local Government Association, thanks to Sir Jeremy Beecham, the founder chairman, and the noble Lord, Lord Bruce-Lockhart, his successor, who has spoken eloquently in this debate, with vital leadership from their chief executives, Sir Brian Briscoe and now Paul Coen, is a clear-sighted, powerful advocate with which government can and do deal with confidence and respect.

In sharp contrast to the time of the Rowntree local government summit in 1996, the scene is now set for real devolution to a new constitutional settlement, which the Bill heralds. As it progresses through its next stages, I will join others in pressing the Government to take further steps towards decentralisation and deregulation and to consider more closely the interface with the voluntary and community sector, which is a vital part of the "double devolution" that goes beyond local authorities to the communities.

At this stage, I congratulate the Government on a Bill which starts the process of change. As we say at the Local Government Association, "Vive la devolution".

Photo of Lord Roberts of Conwy Lord Roberts of Conwy Shadow Minister, Wales 6:44 pm, 20th June 2007

My Lords, I draw your Lordships' attention to the Welsh dimension of the Bill, as I was invited to do by my noble friend on the Opposition Front Bench, Lady Hanham. I am glad to say that the noble Baroness, Lady Morgan, who opened the debate, also mentioned Wales in particular.

I wish to speak about the constitutional aspect of the Welsh dimension, which involves the transfer of primary legislative powers from this Parliament to the National Assembly for Wales. The transfer is achieved in Clause 234, which simply states:

"Schedule 17 (powers of National Assembly for Wales) has effect."

The effect of Schedule 17 is to add five "matters" to the "field" of local government where the Assembly may legislate under the terms of the Government of Wales Act 2006. That Act provides that measures passed by the Assembly—Assembly measures, as they are called—will have the same force as Acts of this Parliament. The first matter added by the schedule enables legislative change in,

"(a) the constitution of new principal areas and the abolition or alteration of existing principal areas, and

(b) the establishment of councils for new principal areas and the abolition of existing principal councils".

In short, we are talking about powers to create and abolish local authorities in a country where we already have single-tier authorities. Of course, in Wales there is no time limit as there is in England.

That is only part of the first matter where legislative power is devolved. There are four more matters relating to local authorities where the Assembly may legislate: bye-laws, conduct of members and employees, community planning and partner authorities, and best value. Of course, local authorities in this context also embrace national parks, fire and rescue authorities and police authorities to a limited extent.

These are substantial, radical powers to devolve in a minor clause and an obscure schedule. They are so minor and so obscure that I can find no mention of them or the powers that they transfer by any speaker at Second Reading of the Bill in another place on22 January this year. In addition, there was barely a mention in Committee or at Third Reading in the other place. Is it credible that the other place disposes of its powers with so little concern and without so much as a passing reference? Apparently it is. The disposal is, incidentally, as permanent as anything done by Parliament can be.

The transfer of what are described as "framework legislative powers" has two precedents, and it will have yet another if the Further Education and Training Bill passes unscathed through the other place. What gives a certain dubious distinction to this Bill is its timing, coming before your Lordships, as it does, shortly after the 3 May election of a new Assembly in Wales. That Assembly is composed differently in membership and governance from its predecessor and is guided by a new, very shaky minority Labour Assembly Government with fresh powers derived from the 2006 Act.

We are bound to ask whether the new Assembly has approved of the contents of the Bill. I doubt it; in fact, I am pretty sure that it has not. Therefore, the UK Government are proceeding on the basis of a consent given by the old, pre-election Assembly. Have the new Assembly Government approved of the contents of the Bill? I doubt that too; I doubt whether they have had time. True, the new Government have much the same faces as the old, but they have been shuffled into new jobs. Their powers are different too.

There is no formal indication that these new bodies have approved the Welsh provisions in the Bill. So the UK Government are gratuitously bringing in these new powers to legislate over local authorities without so much as by leave of the new Assembly or its Government. I doubt whether they have the leave of the local authorities either. That is not so much devolution as imposition of powers. That is made clear in a memorandum from the Secretary of State to the Delegated Powers and Regulatory Reform Committee of your Lordships' House. I shall have more to say on that shortly. Furthermore, we have no real indication of what the new Assembly Government wish to do with those powers. We know from his memorandum what the Secretary of State thinks they might do with them, but there are no Assembly measures in the pipeline as far as we know. So we are, in effect, dishing out blank cheques for legislation.

Another method whereby primary legislative power can be transferred to the National Assembly is by Orders in Council which grant legislative competence in specific areas. The procedure for the approval of such orders has been closely examined by the Welsh Affairs Committee in another place. The procedure has not yet been tried out and, such is its complexity, that I do not think anyone will be in a hurry to do so. But the procedure has the undoubted advantage that it provides for full discussion at every democratic level before a transfer of primary legislative power takes place.

The Delegated Powers and Regulatory Reform Committee has examined the Welsh provisions with its customary thoroughness and I express my sincere appreciation and gratitude to it. The committee stated:

"Whether the particular matters listed in Schedule 17 to this bill should be the subject of enhanced legislative competence for the NAW is a matter of policy for the House".

Some of us would find it easier to decide that issue if there were a clearer indication of how the National Assembly for Wales Government intend to act when they have these powers. The Secretary of State for Wales has anticipated our difficulty and has included in his memorandum to the committee some hints on how the powers might be used. For example, with regard to the power that I quoted at the start of these remarks, the Secretary of State says it might be used,

"for voluntary or directed mergers of local authorities".

Unlike England, Wales does not have a sunset clause, but this is no more than a tantalising inkling of what is in store and comes from a Secretary of State who has only a marginal role in the devolved system compared with the First Minister of the Assembly Government.

For all we know these powers may be used to amalgamate local authorities on a large scale. Once granted by Parliament, these powers cannot easily be withdrawn. I would therefore be grateful if the Minister who is to reply could tell us a little more about the likely application of these powers and provide better and stronger justification for their transfer than we have at present.

Photo of Lord Walton of Detchant Lord Walton of Detchant Crossbench 6:54 pm, 20th June 2007

My Lords, this is an extremely complex and comprehensive Bill which no one could regard as offering light bedtime reading. Like other Members of the House, I shall concentrate solely on Part 14. Many years ago, under another Government, there was a body called the Health Education Council. That Government replaced it with the Health Education Authority and, in turn, replaced with the Health Policy Unit, which vanished without trace. In a debate in this House at the time, I coined a new acronym: RONS—a rose by any other name would smell as sweet. In Part 14 there is something of a powerful aura of the RONS syndrome.

Like many other speakers in this debate, having spent my lifetime working in the National Health Service, I deeply regretted the disappearance of the community health councils and their replacement by forums. Of course, in the past few weeks, I recognise that grammar schools are no longer very popular with any of the political parties, but as a former grammar school boy of more than 70 years ago, I was taught to say "fora", but I know that that pass was sold a long time ago.

In a debate about a month ago, when we were examining certain features of the National Health Service, I pointed out, as the noble Lord, Lord Hunt, knows well, that the report of the NHS Confederation had identified no fewer than 56 bodies and organisations that had the right to assess and comment on the behaviour and performance of NHS authorities. As implied by the noble Baroness, Lady Cumberlege, I suggested that the management of the NHS had become swamped by an intolerable quangocracy. It may be paradoxical, therefore, that I believe that the Commission for Patient and Public Involvement in Health is a quango that is well worth preserving.

When the community health councils died and the commission was created, many of us were very concerned, but the commission and the forums now have a considerable record of achievement in the five years since they were created. Many key impacts have been introduced and achieved, despite their impending abolition, by the dedication and hard work of volunteer forum members who, as others have suggested, are becoming very disenchanted. In particular, a series of national campaigns supported by the Commission for Patient and Public Involvement in Health have brought issues of wide concern to public attention and, subsequently, have been taken up by the Department of Health and the Healthcare Commission. I need only draw the attention of the House to the outstanding report, produced by the commission, entitled Care Watch, an extremely valuable document, particularly at a time when another recent report has shown the great concern that we must all feel about the abuse of elderly people either in their own homes or in care homes throughout the country. It is of great importance.

I firmly believe that it is vital to preserve a public mechanism whereby patients and public voices can be heard on health and social care, identified, as others have said, by the Wanless report and many others. Sharon Grant, the chairman of the Commission for Patient and Public Involvement in Health, has recently said publicly that the Bill represents a very significant step backwards in securing a proper voice for patients and citizens in the NHS. Having studied it carefully, I cannot but share that view. Like the right reverend Prelate the Bishop of Peterborough, I would much prefer to see evolution rather than revolution.

The Bill abolishes the forums and recommends that the LINks—local involvement networks—under local authorities must be created by local authorities contracting with third parties to host each LINk. Which third parties will do that task? The Bill sets out the activities for LINks, their powers and rights, including placing limitations on the duty of service providers to allow them access to premises where services are provided. Unlike forums supported by CPPIH, LINks will have no formal national body to support them, and the Bill narrows the duties of NHS bodies to consult users by specifying that the relevant changes and decisions must be significant. The meaning of "significant" is defined only as being the manner in which services are delivered and the range of services being provided.

In another place, significant concerns were raised on all sides about the abolition of forums, the lack of guidance and direction on how LINks will function, and the lack of any right for a LINk to do spot-check inspections. Concerns were also raised about the reduction in NHS bodies' duties to consult. Having studied the Bill, I regard the terms of the LINks as set out in the Bill—their responsibilities, location and governance—as vague, imprecise and poorly defined. The history of structures being abolished in the NHS and the creation of new and untested institutions does not really breed public confidence. I strongly feel that patients' forums should be developed, be more representative and be reduced in number by substantial mergers, with a revision of their roles so as to cover a wider range of activities, including social care.

The Government have publicly gone on the record as saying that, in the near future, they propose to merge the Council for Social Care Inspection and the Healthcare Commission. That is another merger which is pending. Should they not see what effect that merger has before they go ahead in abolishing the CPPIH which has shown itself to have had a significant role in the past few years? The proposed network model would lack the means to hold the NHS to account and could result in established pressure groups having significantly more influence that those that are not organised. The sheer lack of clarity about the role of LINks and their structure will mean that they will have difficulty in deciding in what they are going to do and how to do it. As a result, they will lose the interest of the volunteers who, after this, they will have difficulty recruiting in any event. They will be expected to do significantly more than forums, without the same budget. Hence there is a serious risk that LINks are being set up to fail.

The Health Committee in another place said that, in its opinion, the existing legislation on consultations should be made to work rather than the law being amended, as the Government propose. The noble Baroness, Lady Andrews, whose inability to speak on this we much regret, has been splendidly supported by her articulate locum tenens today with, I am sure, the admirable support of their minder, the noble Lord, Lord Hunt, on the Front Bench. But I believe that their views have been guided on this legislation and, I fear, misguided on this part of the Bill by their masters—perhaps their mistresses—in another place. This clause deserves serious consideration. To modify the present structure would be an infinitely better solution in the interests of the NHS and of the public at large.

Photo of Lord Dubs Lord Dubs Labour 7:04 pm, 20th June 2007

My Lords, I broadly welcome this Bill. It brings me back to the time when I served as a local councillor, not in the exalted position of the noble Baroness, Lady Hanham, but as an opposition councillor in a Tory-controlled council. Nevertheless, anybody who has had the privilege of serving as a councillor on a local authority—whether in the majority or minority party—will inevitably have learnt a lot about politics and had a real sense of the relationship between local government and local communities. I notice that there are some changes in the Bill on giving local authorities complete powers over by-laws without having to check them with central government. By-laws are important, but I remember amusing occasions when we revised them. It is difficult to get the wording right without it seeming quite humorous at times.

I welcome the Bill because, as had already been said, it transfers power from the centre to local government. For too many years, the movement has been in the other direction. Therefore it can only be a good thing to say that local government should be healthy and made even healthier. We have suffered a great deal from low voter turnout. I am not saying that the Bill would change that overnight, but anything that can be done to make people feel that local government has a power to make a difference in local communities will encourage them to vote. That can only be a good thing.

A number of comments have been made. I suspect that the opposition parties have had difficulties with the Bill. I do not want to inject too much party politics into this evening, but I suspect that when they got the Bill, they said "My God, this is pretty good stuff! How are we going to criticise it? Let's find something to criticise". So they came up with the argument about local government finance. Well, if we local government finance reform were in the Bill, we would certainly not get it through before the Queen's Speech. In any case, everybody in politics accepts that there are two proposals to which Parliament is unlikely to give easy passage. One is reforming the finance of local government, and the other is reforming the membership of this House. Governments take note of that.

I ask two brief questions. First, I see that if a local council elects some of its members every year, it will have the power to change that to all-out elections every third year or so. If a local authority wanted to move in the other direction and have elections annually, I wonder whether it would have the power to do that. I know that people sometimes say that it is better for local democracy to have annual elections. When I was on a local authority for a London borough, we had elections every three or four years. Do the Government intend to give the power in the other direction, or does it only go in one direction?

Secondly, in moving from a possible two-tier structure in local government to a single-tier structure, what will be the basis of local consent to enable that to happen? In other words, if there is unanimity between district councils and the county council, it is fairly obvious. But suppose that there is some disagreement between the county council and one or two of the district councils. Can that be resolved, or does it give a single district council the power of veto? I ask because there are certain areas where these issues are quite hotly contested. There is certainly no agreement, and I wonder what the way forward is.

Briefly, if I am going to make any suggestions for strengthening the Bill, they will be on the voluntary and community sector. It is clear that local area agreements are important and becoming increasingly important. I notice that, in the Commons, the Minister said, in discussing Part 5 of the Bill,

"we cannot deliver our agenda in local communities without the voluntary sector. We cannot involve people, or consult them, or reconnect people with policy, let alone politics, withoutthe voluntary sector. We cannot get the innovation, the focus, the flexibility or, crucially, the trust of the public without the voluntary sector facilitating the relationship".—[Official Report, Commons, Local Government and Public Involvement in Health Bill Committee, 22/2/07; col. 363.]

I think that there would be broad agreement that that is pretty sensible. Therefore, it is rather surprising that the involvement of the voluntary and community sector in the Government's proposals is somewhat weak. There are no provisions in the Bill which fully recognise the importance of the voluntary and community sector as formal members of the arrangements for local area agreements. There is a need for a statutory duty for local authorities to enable voluntary and community organisations to play a full part at local level. The Government said in the Commons that guidance would follow. Well, guidance is guidance and we do not have it before us at all. It would recognise the importance of the voluntary and community sector if they had a statutory responsibility within this.

The Government's view, which they set out in the Commons, is that since the voluntary and community sectors and the business sector are not statutory bodies, a different approach needs to be applied to them. They said that the wording of the Bill,

"puts the onus on the local authority, or gives it the option".—[Official Report, Commons, Local Government and Public Involvement in Health Bill, 22/2/07; col. 363.]

That is pretty weak stuff. We know that in some areas local authorities perform well in this. For example, in Gloucestershire and in Northumberland there are compacts that fully involve the voluntary sector in a wide range of activities and responsibilities. We also know that other local authorities fall short of such a high standard. It would be desirable if the Government were willing to have the Bill strengthened in order to entrench the position of voluntary and community organisations within these local arrangements. That would strengthen the Bill and be a move for the better.

Photo of Viscount Eccles Viscount Eccles Conservative 7:10 pm, 20th June 2007

My Lords, noble Lords who were in the House heard two remarkable maiden speeches that we shall treasure. We also heard from the noble Lord, Lord Smith—who is not in place—that there is some mistrust of local government, or perhaps an overcritical attitude towards it, on this side of the House. I do not share that opinion, nor do I fully share the optimism of the noble Lord, Lord Best, that the tide is turning from centralisation to decentralisation. That is the subject to which I shall address my remarks. As we consider the approach of the Bill to the reform of local government structures, I am still looking for the dividing line between strategy and tactics; I am looking for a direction of travel as well as for the detailed signposts along the way. I am not so certain that we have reached the turning point marked "the decentralisation of central government power".

Over many years, local authorities have been subjected to many attempts to achieve progressive and lasting reform. As yet, local government is still caught up in the continuing tension between systems of central control and the alternative of decentralised local independence with undiminished accountability. Local government also remains threatened by regionalisation. The Bill is silent on the subject, yet parallels with the re-emergence of the European constitution must be in many people's minds. What do the Government believe? Are today's issues better dealt with nationally or locally, but not in between, or only nationally? It is hard to see which issues common to Whitby and Hull are amenable to a regional resolution, for if Whitby has issues in common with Hull, it is certain that those issues will also be present in many other towns and cities, thus calling for a national response. Yet local Whitby issues will not affect Hull. Each town can solve its own issues, but only if it is enabled to do so.

Local authorities are also subject to schools of thought about efficiency and good value derived from the harsh, utilitarian beliefs of their proponents, so we have centralised regimes of targets and league tables. Local authorities also experience the fashion for following single-solution approaches to issues—solutions that are frequently replaced by others when they do not appear to be working too well. We have had that in relation to Part 14. There seems to be a predictable gap of six years between one piece of legislation and the next. That is not an atmosphere that encourages local authorities to innovate when they are constantly up against those who are busy showing that they already know what should be done. It is ironic that the Prime Minister recognised that need and wished to pursue an interesting strategy towards devolved local democracy, had he been able to persuade his colleagues, but as he is ever willing to move on if an idea does not meet with the right response, he accepted the position, leaving only tactics behind.

Now after all those reports and the White Paper, we have the Bill. It is long and mechanistic: all tactics and no strategy. It tackles neither entrenched positions—those of some local education authorities, for example—nor the acceptance among many engaged in local government that they are only the administrators of decisions made elsewhere. Those who argue, as I do, for the real revival of local democracy need to remember that there are many who find that doing administratively that which they have been told to do and then ticking audit boxes is a more comfortable life than management decision-making. Whatever the Bill sets out to do with its utilitarian approach to single tiers, possible adjustments to boundaries—with options for executive structure and for the rules governing elections—even its "will it work" approach to parishes, it will not change the fundamentals of the present settlement between central and local government. Yet a new settlement is the key strategic component of a new and more successful strategy, as the Prime Minister recognised when he wrote in the foreword to the White Paper,

"We want to see local authorities rising to the challenge of leading their areas".

After all the study and the promises, what is missing? It is the money because the shared responsibility for raising the required money is at the heart of any new funding settlement. In the background, the public know only too well that they are heavily taxed. They know who sets and collects the taxes, and they know that all that money confers power. Their perception of local government is that it can do only what it has been funded to do by central government. Rightly or wrongly, council tax is perceived to be centrally controlled. It is interesting that when there are lobbies against council tax, they take place outside the Houses of Parliament. Conscious that he who pays the piper calls the tune, why should the public become engaged in, and by, the work of local authorities?

The world of league table and targets reinforces this disengagement. It is possible to climb up this league table only by conforming to benchmarks that are set centrally because in this league, there are no contests that produce a clear result—win, lose or draw—nor is there much hope of persuading the adjudicators to agree to different or special circumstances. The best that can be done is to duck and weave in the interests of independence while mastering the presentation of conformity, which is not a good recipe for local engagement.

The Bill promises some light-touch relief, but will it happen? I judge that it will not happen until there is a major change in the funding settlement between central and local government. That brings us back to money. If local authorities are to be truly representative, they need the power to raise a much more significant proportion of the necessary money. As my noble friend Lady Hanham said, that may be to grasp a nettle, but nevertheless, the choice is clear. The public understand that responsibility and accountability go together and will be achieved only when the public can call local authorities to account for the way they raise and spend the public's money. Of course there are problems to be solved, but they are surely not beyond the capability of the incoming Prime Minister.

The fact remains that to achieve the local leadership that is needed—the type of independent leadership called for by the Prime Minister, which will engage the public and recruit into local government those who can deliver—we need a new funding settlement between central and local government. Meanwhile, this long and mechanistic Bill contains no such direction of travel. However much we discuss and amend it, it will remain yet another appearance of reform rather than the reality.

Photo of Baroness Meacher Baroness Meacher Crossbench 7:20 pm, 20th June 2007

My Lords, I want to focus on the fourth key element of the Bill, Part 14, and to welcome the Government's proposed new local government networks. Public involvement in the provision of health and social services transforms the experience of patients and service users if it is well organised and well supported. It has to be said that the PPI forums were not well organised and well supported. The proposal for a well established organisation, probably in the voluntary sector, to host the network and to provide strong leadership, support and governance structures, is to be welcomed. I will make two general points and then focus on my concern about the application of the LINks to mental health.

Sadly, this reform is regarded by many as yet another example of the Government's obsession with changes to services in the NHS. The fact is that endless change has done much to destroy morale in the NHS and to undermine the quality of service. I, for one, am hoping that our new Prime Minister may herald a new era of stability.

As other noble Lords have noted, patient and public involvement forums were established at the end of 2003. Only six months later, in June 2004, the Government announced that the oversight body—the Commission for Patient and Public Involvement in Health—would be abolished. Since 2003, a variety of proposals has affected patient and public involvement, complicated by a lack of clear policy direction.

During this period, my experience at the head of a mental health trust has been that PPI forums have limped along, but with the energy of a boat holed below the waterline. Service users have been very reluctant to become involved. After such a record, it is incredibly important that these reforms are a success and that the LINks remain in place for years to come, modified, I hope, over time but not torn up to join so many other organisations on the scrap heap.

My second general point is that the Department of Health at times—I do not say always—fails to achieve joined-up government within the department, let alone across to other government departments. It is not clear that the Government have considered this reform in the context of the emergence of foundation trusts across the country. The proposed LINks will be responsible for ensuring that the public are involved in the provision of local health as well as social services, commissioning and scrutiny of those services. At the same time, foundation trusts are establishing boards of governors, supported by thousands of independent members, including service users, carers and other members of the public. It is difficult to see the differences between the concept of the LINk and these boards of governors and members. A key role of foundation trust boards of governors is to ensure that health services respond to the needs of the community and of patients in particular—precisely the role of the proposed LINks.

I emphasise again my support for public involvement in the provision of services. The new LINks will surely be a constructive and helpful way forward for local authority services and commissioning where there is no effective public involvement framework, as well as for any NHS trust that has not become a foundation trust when the new LINks are established.

My concern is that the potential for duplication of the public involvement role across foundation trusts will be confusing and unhelpful in the context of recent developments increasingly to integrate the mental health services. Secondary mental health trusts work more closely with primary care than ever before and this trend is increasing fast with the prospect of practice-based commissioning. Social work in mental health is now fully integrated within mental health trusts. Social workers are seconded to the trust and managed alongside doctors, nurses and OTs in community mental health teams and on the wards. A consultant will be responsible for a patient on a ward and is involved in the care of the patient through the community mental health team when that patient goes home. Does it make sense for the board of governors of the trust to be concerned about his care one week and the LINk to take over that responsibility when he goes home the following week, or, worse still, for both bodies to be falling over each other doing the same job in the same place for the same people?

As the chair of a mental health trust, I can assure the House that the service users and carers on the board of governors will expect to be involved inthe community care provision of the trust as well as the ward or hospital-based provision. They will not take kindly to the idea that this is the responsibility of a LINk—a separate organisation contracted by the local authority to carry out these responsibilities.

Can the Minister assure the House that he will give due consideration to whether the very similar work of LINks and FT boards of governors can be implemented without duplication? He may want to argue that a bit of duplication will not do any harm. He will need to take account of all the existing oversight bodies—the number 56 has already been mentioned.

I will give just a few examples. In mental health, in-patient units already have regular visits, announced and unannounced, from Mental Health Act commissioners and the Healthcare Commission, although it is hoped that with the merging of these two bodies—and I welcome that merger—these visits will be co-ordinated. They also have visits from solicitors and others regarding tribunal hearings, and from dozens of other people, including advocates and so on. We should add to that the visits that they will no doubt have from foundation trust governors. We are not yet a foundation trust, so I talk about this in the future, but of course many other trusts are already foundation trusts.

Will visits from yet another oversight body be in the best interests of patients? I hope that the Minister will give the House the benefit of his views on this point. Indeed, I ask him to consider whether guidance may be appropriate to make it clear that the LINks should focus on local authority services and commissioning, and perhaps on health services only in those trusts that are not foundation trusts when LINks become operational.

The Health Select Committee assumes that the LINks will not be interested in the commissioning side of the work, but surely when LINks understand the enormously important role of commissioning in defining the future shape of health services in this country they will want to play a key role in involving patients and carers in that work, as well as, of course, in the delivery of local authority services.

Finally, I understand that early adopter projects will trial the LINks. I understand that these projects are being evaluated. Will the Minister provide the House with the results of the evaluation of these early adopter projects? Can he inform the House when these results will be available? Also, will he assure the House that the Bill will not be set in stone before the results of the evaluation can be taken fully into account and that the guidance for the delivery of the LINks will be drawn up only after the results of the evaluation are known?

In summary, I welcome the broader remit of LINks when compared with PPI forums. The LINks would do well to learn from the experience of boards of governors, the model that is now well established in NHS foundation trusts. I hope that the Minister will take my comments as evidence of my commitment to the success of the new arrangements. I look forward to hearing what he will say.

Photo of Lord Graham of Edmonton Lord Graham of Edmonton Labour 7:28 pm, 20th June 2007

My Lords, it has been a pleasure to listen to this well informed debate. I am grateful to all noble Lords who have taken part, as they have helped me to understand better many of the intricacies of local government today. It is always difficult to relate to the experience that people bring from the front line. I look at the noble Lord, Lord Hanningfield. Every day of his life he is involved with some aspect of local government because he is the leader of Essex County Council. As an Essex council tax payer, I pay due respect to him and I hope that next year he will do his job better than he did last year.

I begin by referring to the two maiden speeches. I was absolutely delighted by what the noble Lords said, but also by their attitude. They reminded me of the day, 23 years ago, when I first entered this House, because they had an air of excitement about what they could do in this place. They retailed to us their enormous involvement in community affairs and said that they were looking forward to being able to advance the interest that they have shown. It was a joy and a pleasure to hear both of them.

I jotted down one phrase from the speech of the noble Lord, Lord Mawson, about letting people become local leaders if they want to. There is something of a myth that everybody in the community has a point of view and wants to become involved. Sadly, from my involvement in local government, which now goes back 50 years, as a councillor for more than 40 years and as the leader of a London borough, I know that that is not always true. A great deal of excitement is generated by the local press and by agitations. I can recall going to meetings of residents' associations, parent-teacher associations and local business clubs where, of course, there were articulate men and women who had a point of view. I respected them very much. But we must be careful not to mislead ourselves into thinking that outside this place the rest of the community is a hive of activity dreaming up ideas and criticising what we are doing.

I was depressed at the beginning of this debate by the negative tone introduced by some speakers. No one will ever get it right. The good old days to which they referred, before the Bill came along, were under the very Acts that they opposed strenuously when they were proposed five, 10 or 15 years ago. In other words, if you are in opposition—as I was for many years in this Chamber—it is never got right. I tell the Minister and his ministerial colleagues and others that they should be congratulated on at least perceiving the opportunity that may well arise. There will be moments when they believe that they have it right but when the weight of opinion, as expressed tonight and perhaps in votes in this place, indicates to them that they have got it wrong.

The job of Ministers and their Back-Benchers—I am proud to be one of them—is to ensure that the legislation goes through. I am heartened by the fact that in the Commons many amendments were made to the Bill in the light of representations made from all round the House. I remember one Bill that came to us in the Lords in the mid-1980s, the Financial Services Bill, that brought with it 1,000 amendments that the Government had accepted—not written into the Bill, but which they said that they would put right in the Lords.

I am not privy to what is happening, but I am certain that the Minister and her colleagues will have a number of amendments that will surprise and delight many others. I think that they would do well to reflect as pressure mounts on various points made—I have listened to them all and sympathise with many of them, because they have given me a fresh perspective on the issue—and take those points forward. People have used the phrase, "This is an opportunity that has been missed". The opportunity is still there. Everyone with a point of view is hoping that the opportunity will be taken, not missed.

I enjoyed very much the flavour that I got of the deep involvement in local government of the noble Lord, Lord Bruce-Lockhart, whom I welcome back to his place. However, the brief that the Local Government Association sent to many of us stated:

"What's good news for councils and the people they represent?

The bill takes steps towards decentralisation and deregulation in the Local Government White Paper around political leadership, democratic representation and tackling bureaucratic burdens;

The government has been positive on LGA concerns on council restructuring, NHS and Foundation Trusts in LAAs, the creation of joint waste authorities and byelaw devolution".

I will not repeat what it says under the heading, "What's the bad news?", which is also in the brief, but there is good news there. We must recognise that in local government you do not win it all and you do not win it all at the right time.

One of my favourite plays is Arthur Miller's A View from the Bridge. The central character, apart from the tragedy of the play, is an interlocutor who periodically comes on to the stage and explains the background to the audience. Briefly, the background is that illegal immigrants living on the waterside are under some pressure from the police. The interlocutor says more than once, "In this community, we learn to settle for half". If in politics you achieve half of what you want each time you try, that is progress.

I am sorry to hear carping criticism of the Government's intentions because, in my view, they are genuinely trying to recognise that there has been a groundswell and a shift in how local people view their rights and responsibilities now compared to more than 40 years ago, when I was leader of the London Borough of Enfield. It is a different world. We must recognise that there are pressure groups and single-issue groups. There is a need locally for the strategic approach that the Government seek to implement, whereby the local council is responsible not merely for what it has been responsible for in the past, but for trying to create a strategic weapon through partnerships with other authorities and bodies—not only local authorities in general, but voluntary bodies in its community. That is good and must be strengthened.

As always, we are beaten for time. As far as I am concerned, the Government are listening, but they need to listen more. The prize is well worth winning. The people of this country have been patient. We will never get it completely right; we will never get it right at the right time; but the Government should be congratulated on not giving up on the need to improve the present relationship between central and local government. The great thing that they are doing is to devolve as far as they can powers that, hitherto, have been the province of central government and say to local government: "That's all right; you get on with it". The Local Government Association states simply that it supports strong leadership but thinks that no single model will suit all councils. That is absolutely right. No one solution fits all.

You have to leave it to local people. They will scream, of course. When I was in the Whips' Office, the greatest joy I had was to stand outside the door when my colleagues came in and asked, "Which way do I vote?". I would say, "There is no Whip on". "Yes, but which way?" I would say, "Look, it is up to you. You've got to make your own decision". They were in a terrible state because the Whips were saying, "It's up to you". Local people will be forced to be more responsible and responsive to the needs of their community because of the powers that the Bill gives.

Finally, everyone has to appreciate that all people, including the disabled, the vulnerable and the feckless, need the support of strong leadership, not only centrally but also locally. This Bill is well on the way to doing that and I congratulate the Government.

Photo of Lord Boston of Faversham Lord Boston of Faversham Crossbench 7:40 pm, 20th June 2007

My Lords, I support this important legislation for it has the potential to empower local communities and to enhance the capacity of local government to provide more effective and more accountable strategic leadership, to which the noble Lord, Lord Graham of Edmonton, has just referred. This Bill also offers an opportunity to rectify an anomaly that has existed since 1980, which discriminates against some of the very local authorities whose role the Bill seeks to enhance for the benefit of their local communities. I refer to the Cinque Port towns in Kent and East Sussex. They have not been raised so far in this debate, and I hope that noble Lords will forgive me for raising them now.

Until 1974, all but one of the 14 Cinque Port towns were municipal boroughs with a history and civic traditions dating back almost 1,000 years. As boroughs, they enjoyed the ancient right to confer the freedom of their towns on distinguished national figures and those who had devoted a lifetime of voluntary service to their local communities. The Local Government Act 1972, which came into effect in 1974, abolished all the ancient municipal boroughs. Many, including 12 of the Cinque Ports, were too small to become local government districts in their own right. In the majority of cases, they became "successor parishes", which exercised the right to be called "town councils" and for their chairman to be known as the "town mayor". Some of the larger towns did not meet the Government's criteria.

From 1974, they were represented by "charter trustees"; that is, the district councillors for the wards comprising the ancient borough were recognised as having the continuing right to elect a town mayor and such honorary officials as had been appointed previously by the borough council. A number of these have since become town councils, leaving only Margate and Ramsgate represented by charter trustees. However, the 1972 Act stripped all former boroughs of the right to confer the freedom of their towns.

My main purpose in speaking is to give notice that I will seek to introduce an amendment in Committee to restore that right, but I will not, of course, go into the detail today because I would be going against the Companion if I did. It is a very modest, but significant, amendment. In January, I was approached by the registrar and seneschal of the Cinque Ports, Mr Ian Russell, to support that aim and I agreed to do so. A number of noble Lords support this idea, including my noble and gallant friend Lord Boyce, the Lord Warden of the Cinque Ports. After that, I approached the Secretary of State. I am delighted to say that a recent letter from Mr Phil Woolas, Minister for Local Government and Community Cohesion, stated that the Government are sympathetic to this idea, but are not convinced that this Bill is the right vehicle. I hope and will seek to convince them in due course.

I declare an interest. I was approached by the registrar and seneschal because of a Cinque Ports connection. In another place, I represented the Faversham constituency, as it was then called, which included the town of Faversham, an associate Cinque Port. Furthermore—I must give another declaration of interest—my arms, granted not long ago, also have a Cinque Ports connection. The Cinque Ports arms have three stern ends of ships—half-hulls, in effect—each attached to three front halves of lions. For my arms, I chose to have just one half-hull attached to one half-lion. I felt that it would be a trifle presumptuous to seek to have all three, so I aimed to settle for just one. Iam glad to say that that was approved by College of Arms and incorporated into my arms. I was assisted greatly by the Richmond Herald of Arms, Mr Patric Dickinson.

I apologise for describing my half-hull and lion in layman's terms. But knowing your Lordships, I realise that you will require it in heraldic terms. It is described,

"per pale gules and azure a lion passant guardant dimidiated with a ship's hull or on a chief argent".

Noble Lords of course will know that "or" refers to gold.

I should like to thank the Public Bill Office for its considerable and most helpful advice and guidanceon this matter. I am advised that my proposed amendment is relevant, so I trust that that will give some comfort and encouragement to the Ministers dealing with this Bill, not least the noble Baroness, Lady Andrews. I wish those Ministers every success with the passage of this Bill.

Photo of Baroness Neuberger Baroness Neuberger Spokesperson in the Lords, Health 7:48 pm, 20th June 2007

My Lords, I wind up for these Benches in this debate because of the unavoidable absence of my noble friend Lady Scott of Needham Market who cannot be with us because of a family bereavement. Therefore, I will concentrate as I would have done in other circumstances on the patient and public involvement section, as I am no expert on local government. Before I do that, I should like to welcome the maiden speeches and congratulate those who made them, particularly the noble Baroness, Lady Campbell of Surbiton. She made a wonderful speech, but also I think that the whole House would like to pay tribute to her for all her wonderful work throughout her career. The noble Lord, Lord Mawson, is an old friend, colleague and sparring partner from my days at the King's Fund. He made a terrific and wonderful speech, which I am sure we will all take on board. I am sure that I also speak on behalf of the whole House in wishing the noble Baroness, Lady Andrews, well. I thought that when we acted as a whole House in a cross-party manner and tried to persuade someone to go home, they might take some notice, but she has not. I still wish that she would, but I imagine we do not have long to go. Before I move on to the patient and public involvement part of the Bill, I should like to echo the sentiments expressed by the noble Lord, Lord Dubs, about the role that voluntary organisations should be playing in local area agreements. As someone who has worked all my professional life in the voluntary sector—other than when I have chaired organisations in the statutory sector—unless it is taken seriously, it will not really work. It puts the voluntary sector, which plays such a major part in our society, at a considerable disadvantage. I hope that the Minister will be able to say something about that.

I come now to the question of patient and public involvement in health. Like the noble Lord, Lord Low of Dalston, we on these Benches have considerable reservations about the Government's proposals. Noble Lords will have received many letters on the issue. The Government propose to abolish the Commission for Patient and Public Involvement in Health and the patients' forums that now exist around the country and replace the system, itself only just four years old, with a new one—that of LINks, or local involvement networks. They are to be fairly loose networks of a variety of people who have an interest, but whose budgets will go to the relevant local authority which in its turn will give the money to a host organisation to manage on its behalf, so that the LINks themselves will have few powers and duties of their own. I am sure that the Minister will tell noble Lords that this is at least in part to save LINks the huge administrative burden of employing and managing relatively few staff. While I understand the point, I do not believe it is possible, from my experience in both the statutory and voluntary sectors, for an organisation to be able to function seriously and effectively if it does not have the capacity to choose who it hires and, occasionally, who it fires. The idea of the local authority choosing the host organisation, and LINks having little power to reject that choice, does not appeal.

I have read the draft policy statement kindly provided by the Minister describing the LINks powers to be established in regulations, and I am grateful to him. But although it gives us some detail about the right to enter and inspect premises—or otherwise, the ones that cannot be visited—it fails to clarify: the very nature of the LINks, which is their statutory standing, as the noble Earl, Lord Howe, said; their ability to hold local health and social commissioning to account; and their ability to make decisions about their future, including the host organisation. I would be grateful to the Minister if he could respond to the very considerable concerns felt by large numbers of people, members of present patients' forums and others, who have been in touch with many of us around this House. I am also grateful to Malcolm Alexander of the National Association of Patient and Public Forum Involvement Organisation for all his advice. I thank also the Royal College of Nursing, Elizabeth Manero of Health Link and others who have written.

But there is more. One role that patients' forums have carried out, and CHCs before them—as the Minister will know all too well from the days when he and I first met and he was a CHC secretary—is spot checks and general inspections of NHS premises. The NHS organisations concerned—I speak as a former chair of Camden and Islington Community Health Services NHS Trust—have not always liked or appreciated those visits. Yet for local people they have played a key role, and if a patient and user-centred service is really what we want to achieve, some rights of inspection are needed if those patients are to feel that they are being taken seriously. For the most vulnerable, this is absolutely essential, as was made very clear by several noble Lords, including the noble Earl, Lord Howe, and the noble Lord, Lord Walton.

The 2006 White Paper, Our Health, Our Care, Our Say, states:

"The challenge to commissioners is how to make greater local voice, choice and control a reality".

It continues,

"systematically and rigorously finding out what people want and need from their services is a fundamental duty of commissioners ... organisations commissioning NHS-funded care must ensure local people play a full part in the planning, design and delivery of their services".

I argue that local people cannot play that role with commissioners in partnership if the right to visit and inspect is all but removed. I know that the Minister will say that authorised people from LINks, provided they have checked with the Healthcare Commission or the Commission for Social Care Inspection, or whatever merged body succeeds them, will be able to visit despite the burden that that places on organisations. We all recognise the problem of over-inspection and over-visiting, as the noble Lord, Lord Walton, has mentioned, but if the Government were serious, they would go further and say that a member of a patients' forum now or a LINk in the future should be included in every inspection team that visits from the Healthcare Commission or CSCI—and I do not believe that the Healthcare Commission would be totally opposed to that. It would add to the teeth of the local forums or LINks, but their ability to visit for spot checks should not be so summarily dismissed or hampered, as the present proposals suggest; that their capacity to really listen, feel and engage with services is seriously limited.

That is all the more serious because of the report from the Picker Institute, which came out today. It shows that the majority of PCTs are themselves not ready to meet the new challenge of integrating patient and public involvement into all aspects of their commissioning strategies. Few trusts have finalised plans for the new elements of patient and public involvement they are expected to use, and that includes LINks, patient-initiated petitions and the patient prospectus; nor have they integrated patient and public involvement into commissioning at high management or budgetary levels; they have not built in experience of deliberative processes with the public, as opposed to taking snapshots of opinion; and they have not used patient and public involvement in parts of commissioning other than service redesign, such as assessing needs, determining priorities and evaluating services.

Moreover, the Picker survey shows that the majority of PCTs have low expectations of the outcomes of patient and public involvement. They do not expect patients' forums, voluntary organisations and patient groups to be "highly influential" in commissioning decisions, and they expect the new patient and public involvement mechanisms to affect the process of making commissioning decisions more than their substance. The survey identifies various challenges faced by the PCTs, including reaching seldom-heard groups, getting reliable data on patient experiences, and the public's lack of knowledge of what commissioning means. PCTs also often cite the lack of support from senior executives and the lack of conviction of senior clinicians as among the greatest barriers. The noble Baroness, Lady Meacher, was right to say that patient and public involvement in commissioning is essential, and she is also right to point out that some of the roles in this new legislation appear to overlap considerably with those of the governors of foundation trusts. We really have to sort it out if, as the Picker Institute has pointed out today, the trusts do not quite understand what the role is.

As if that is not enough to suggest that we should be cautious about limiting the powers of patients' forums or LINks, as many noble Lords know, there was a major King's Fund and Age Concern event last Saturday—here I declare an interest as a former chief executive. I was not there, but I know people who were. The Chancellor and Prime Minister-elect attended to listen to the views of the public and healthcare professionals on the key issues facing the NHS. At the end, the Chancellor said:

"You cannot have a Government that just tries to pull levers. You have to talk to people and take their views into account. We need a better way to listen to people and act on what they say. If we don't listen, we'll get things wrong. Bringing patients and NHS employees together is the way forward".

The future Prime Minister is right. Bringing patients, the public and staff together is an important way forward. Thus far, the Government's proposals do not achieve that. Instead, they have upset the very people they need to encourage as the core of any new system. We are not saying from these Benches that patient and public involvement could not be done better. The noble Baroness, Lady Campbell of Surbiton, in her maiden speech made a strong play for how many things could be done better. We believe that there are excellent arguments for bringing health and social care public involvement closer together. Like the right reverend Prelate the Bishop of Peterborough, we believe in evolution rather than revolution and, like the future Prime Minister, we believe that it could get better. We would like to see far greater democracy within local health services to help it do so.

However, we are where we are, and that is rather unsatisfactory. LINks have unclear powers, no control over their funds, limited access and an insufficient role in enabling people to take responsibility, as the noble Lord, Lord Mawson, made clear. They will also have a poor capacity to hold services to account. Accountability is a key question, as many noble Lords around the Chamber pointed out. The UK scores badly both in its patient and public involvement, as the Bristol inquiry made all too clear. The noble Earl, Lord Howe, mentioned that.

But the issue of patient involvement often slips to the bottom of the heap despite the clear evidence that Angela Coulter from the Picker Institute gave to the Health Select Committee inquiry, which shows that engaging patients in treatment decisions and in managing their own health improves the appropriateness of care, improves health outcomes, reduces risk factors and prevents ill health; it leads to more cost-effective outcomes, moderates demand, improves safety and reduces complaints and litigation. Patient involvement changes behaviour in the whole health community, but behaviours in the wider agenda of patient and public involvement need to change in order to allow it to take place properly. Patient involvement will not be the norm until the whole system faces outwards to patients more successfully. LINks as presently proposed do not appear to have the powers to enable them to do that.

There is one further issue I wish to address before moving to some questions for the Minister. In Clause 232(1B) the word "significant" has been added to the Bill, reducing substantially the opportunities for individuals and communities to influence service provision and the commissioning of services. As other noble Lords have said, who is going to define "significant" and to what extent do the Government believe that this will even further limit the ability of communities to influence the commissioning of services, given that LINks are not to have any power to do so? I am left uncomfortable with the lack of clarity, the lack of powers, the lack of ownership of their own destiny and the lack of a sense of serious commitment to patient and public involvement.

I regret that the forums have not had longer to carry out their work and I am highly dubious about the pace of this change. I feel that all the more strongly after conversations with many forum members, including Robin Tuck, chair of Kensington and Chelsea patients' forum, the only "early adopter" in London. He made several important points in his conversation with me. His key concerns, as they are of many others, are about who holds the money. You cannot have LINks being asked to be in touch with patients and the public to find out their views without doing research, but it is the host, not the LINk, which has to commission the work because it holds the purse strings. He also cites, as does everyone else, the issue of entry to NHS premises and suggests that LINks must be able to suggest remedies where things go wrong as well, for local voices often do know about local situations and local solutions.

But, above and beyond all this, he and others all raised the question of the pace; evolution, not revolution, as the right reverend Prelate has said. What is the hurry here? The early adopters are not ready; the system is clearly not ready; the future Prime Minister is suggesting that we need to think hard about how we have these conversations; and the Health Select Committee has major concerns. Few are suggesting that patient and public involvement could not be improved. The patient forums could get together on an area basis informally; they could work differently.

The present forums are full of volunteers—people who give their time, energy and commitment. They feel upset, angry and betrayed. The Government want to encourage volunteering. I chair the commission on the future of volunteering in England and I welcome the Government's commitment to volunteers and volunteering, but you do not encourage volunteers by riding roughshod over their concerns, and there are simply too many people writing and speaking out for this to be a fringe interest. Some of those people, as the noble Baroness, Lady Cumberlege, said, came originally from the community health councils, which were abolished, and they volunteered for the patient forums, which are now to be abolished. Forums were not included in the Government's review of patient and public involvement—a mistake, in my view— although the members of that expert panel were very good. Some of them were my former colleagues from the King's Fund.

But the members of patient forums rightly feel disaffected and unthanked. We on these Benches will want to see significant changes to the proposals and significant delays in the change to the new system if we—the present forum members and many others—are to have confidence in the new system. Transitional arrangements are barely there, as many noble Lords have said, and the need for training and support is simply unrecognised. Unless we see considerable changes as well as clear powers and accountability structures for LINks on the face of the Bill, we will have considerable difficulty in supporting this section of it.

My noble friend Lady Hamwee very charmingly said at the beginning of her remarks that I was neither old nor grumpy. On this Bill, without clarification and changes, I might well become quite grumpy and probably quite old in the process.

Photo of Lord Hanningfield Lord Hanningfield Deputy Chief Whip, Whips, Shadow Minister, Transport, Shadow Minister, Communities and Local Government 8:05 pm, 20th June 2007

My Lords, I am grateful for this opportunity to speak at the end of this stimulating and wide-ranging debate. I, too, commiserate with the noble Baroness, Lady Andrews. I think she has given her throat infection to me and I may start coughing during my speech. We know how she was suffering yesterday.

I, too, congratulate the noble Baroness, Lady Campbell, and the noble Lord, Lord Mawson, on their magnificent maiden speeches. I am sure they will have a tremendous part to play in the House given their vast knowledge of voluntary service and so on.

We have had an extraordinary debate. We were talking mainly about local government but we may or may not have solved the problems of the health service. I commiserate with the noble Lord, Lord Hunt, who is to reply to the debate. When I was talking to him earlier today he said that he had to read the whole

Bill this morning to be able to answer this afternoon. So I shall commiserate with him in a little while when he replies. We have debated the health service and the Sunday trading laws, and we have had a great insight into the Cinque Ports. We have learnt a great deal today.

I particularly thank my noble friends Lord Howe and Lady Cumberlege for their contributions on the health side of the Bill; they have a vast knowledge of that and I do not. I also thank my noble friend Lord Bruce-Lockhart, who made a valuable contribution as chairman of the Local Government Association. It will be his last appearance in that role as he gives up the appointment in a week's time.

I turn now to the legislation and my comments may not be quite so light-hearted. The Secretary of State stated that this Bill would contain,

"significant proposals to empower communities, enhance the leadership role of local government and bring about a radical change in the nature of the relationship between central government and local government and its partners".—[Hansard, Commons, 22/1/07; col. 1155.]

I do not doubt that several proposals are significant or that local leadership will be enhanced by the Bill's provisions, but will the Bill bring radical change between central and local government? I am afraid the answer is no. Will the Bill help me to act more decisively as leader of Essex County Council? I should explain to the noble Lord, Lord Graham, that I am leader, not the chairman. I prefer to be leader because the chairman does not have any powers these days. Will the Bill help me do more as leader, representing the interests of 1.4 million people, on issues such as transport or affordable housing? A key test of the Bill is what tangible difference it will make to people's lives. I do not think it will be very much.

We all know that "localist" rhetoric is in full swing on both sides of the political divide; localism is very much in vogue. But I sometimes feel that all things local—democracy, delivery and enhancing the quality of life—are still a foreign language to central government. It is still a case of "nanny knows best". It was the same when my party was in power some years ago; I do not think the philosophy of central government has changed too much. The Bill forces me to ask: when will we genuinely give back power to local people? When will central government catch up with what the best of local government is already doing? Local government has been doing great things over the past few years and is ahead of national government in the way it operates.

We have heard today how the Bill completely ducks the issue—there have been various phrases—of funding local government. This is not a red herring, as the noble Lord, Lord Dubs, said, but a very vital issue. My noble friend Lord Eccles put it very well in his contribution. Perhaps the Government are hoping that the Lyons report will somehow disappear, another casualty in the long fight for a simple, sustainable local government finance system. We will return to these issues in Committee.

As several noble Lords have said, the Bill is a waste of an outstanding opportunity finally to devolve powers over planning, housing, transport, skills and economic development from national Government and regional quangos to democratic, local councils. It could have been a flagship Bill, perhaps even a legacy Bill. Unfortunately, the Government are going around in circles on the issue of devolution. I do not believe that the Bill will alter the fact that we are one of the most centralised democracies in the modern western world—other than, as everyone says, Malta, which has only about 30,000 people anyway. We are certainly the most centralised country in Europe.

I shall now touch on some of the issues that have been addressed today about which I would like to make some contribution. We are unequivocally against the latest, pointless reorganisation of local government. I personally stand against the wish of Governments, of whatever political party, to keep redrawing the administrative boundaries of England. Do the Government recognise the damage they have done in creating a district/county war up and down the country? Norwich and Norfolk, Chester and Cheshire, Bedford and Bedfordshire, Ipswich and Suffolk, Shrewsbury and Shropshire—they have been fighting each other all the time. No doubt they are all distracted from working together to deliver better services for their citizens. For how long can the chaos continue? The noble Baroness, Lady Morgan, mentioned a timetable at the beginning of the debate—I congratulate her on her introduction of the Bill—but that does not really help. Reorganisation rarely delivers the promised savings. Indeed, the Chief Secretary to the Treasury seems to agree. I urge the Government to bring this sorry episode to a close as soon as possible so that councils can get on with their proper job of serving the public.

We welcome the thrust of the Government's proposals for developing the role of parish councils, particularly in allowing local people to petition for parishing and extending the power of well-being to certain parishes. However, I ask the Minister to consider the reservations highlighted by my noble friend Lady Hanham, regarding the impact of this legislation on London. I also draw attention to the importance of county councils in supporting parishes in two-tier authorities and suggest that a way can be found to bring them, as well as district councils, into the process of creating and extending parishes.

With regard to the proposals for local partners and co-operation under Part 5, we are glad that the Bill is heading in the right direction. Once again, however, the Government could have gone further. They have not followed their own reasoning through to its logical, and localist, conclusions. Very few of us would dispute that LAAs are a welcome initiative. To try to use all the money that is spent in an area in the best way is obviously the right way forward. I am committed to pursuing the council's role as the convenor of local public services. We need maximum flexibility to do the job properly, though, and in Committee we will be seeking clarification from the Minister about how she sees the proposed duty of co-operation working in practice.

Of all the issues in this Bill, the most important to me is to tackle the culture of national targets. We need a veritable bonfire of national targets if we are to renew local democracy and improve local service delivery. The Bill will go far enough for me only when Whitehall demonstrates that it truly wishes to empower local government by setting an upper limit on nationally designated targets for LAAs. We will table amendments to ensure that that is the case.

We also welcome the extended powers of scrutiny outlined in the Bill and the recognition of councillors as local democratic champions. However, once again the Bill does not meet the expectations raised by the White Paper. While we wholly support the Bill in extending the scope of scrutiny to cover some partners involved in the delivery of the LAA, we feel that the list of those partners is not sufficiently comprehensive. All organisations involved in the delivery of the LAA targets should be subject to the same scrutiny as local authorities. We also believe that representatives should be required to attend in person if requested. There has been a lot of this when have tried to carry out scrutiny of local government; some people just do not turn up. How can you scrutinise them? That needs to be a requirement.

We will also pursue amendments to bring the provisions for the Community Call for Action in the Bill and the Police and Justice Act under one single mechanism; otherwise, this welcome initiative will simply be too confusing.

I move on to the issue of by-laws. Although a minor provision within a large Bill, this devolutionary provision is welcome. However, in Committee we wish to ensure that the proposals to devolve by-laws will apply across all government departments: for example, by-laws regulating the use of taxis and walkways, which is the responsibility of the Department for Transport, local nature reserves, which are the responsibility of Defra, and public libraries, which are the responsibility of the DCMS, do not appear to be covered by the Bill's provisions. Why should devolution stop at the doors of the DCLG?

On the subject of best value, I should like to reiterate the point made earlier by my noble friend Lady Hanham. Best value reviews and performance plans will not be missed, but it is vital that the targetry and obsession with audit processes associated with best value do not creep in through the back door under the new LAA regime.

We welcome the permissive measures introduced, following the LGA's lobbying, on joint waste authorities. We will, however, wish to probe the Government's thinking more closely in Committee. We will wish to explore exactly what benefits are anticipated beyond those that could be achieved by existing regulatory structures, such as joint committees and special purpose vehicles. We will wish to explore whether the Government could go further with this legislation to encourage greater private sector investment in waste disposal, collection and recycling.

I shall mention one measure that could be classified as "miscellaneous": local authority communications. As a county council leader, I believe that the time has come to reform the code of conduct for local authority publicity. Increasingly, local authorities seek, and indeed are expected, to meet the challenges of place-shaping and promoting social cohesion. That role demands greater confidence and flexibility, especially when it comes to communications. The current code does not provide the clear and confident guidance needed by councils, resulting in excessive caution that can undermine effective engagement with communities. The existing code should be either substantially revised or replaced with voluntary guidelines. It will be important that the framework, whether statutory or voluntary, is simpler, allows local discretion and, in particular, supports councillors' advocacy role for their constituents. We would like to explore how we can achieve that with the Minister in Committee.

The Government have the right aims in attempting to strengthen local democracy and local services. Unfortunately, I do not believe that the Bill as currently drafted will be equal to the task. I reiterate my earlier point that fundamentally it is devolved democratic powers and a sustainable funding system that would deliver the Government's aims of local leadership and empowered communities. None the less, the Bill contains some welcome deregulatory provisions, and where we still believe the legislation to be deficient, I will be working closely with my noble friend Lady Hanham to improve it in Committee.

Photo of Lord Hunt of Kings Heath Lord Hunt of Kings Heath Minister of State, Department of Health, Minister of State (Department of Health) (NHS Reform) 8:18 pm, 20th June 2007

My Lords, I confess that I had not expected to be standing here winding up today, but it has been a real privilege to have listened to such an excellent debate. My noble friends and I look forward to debating this issue further in Committee. We all hope that my noble friend Lady Andrews will be back in full voice before Committee stage; I certainly do.

It is with some trepidation that I attempt to respond on these important matters of local government to so many experts in the Chamber today. Like the noble Baroness, Lady Cumberlege, I have local government experience—I was a member of Oxford City Council at the age of 24—but that was quite some time ago. It would be foolhardy for me to attempt to respond using that experience, gained way back in 1973.

There was a sense, when I listened to some noble Lords, of a golden age of local government freedom when central government were content to hand out the money and let local government get on with it. I can assure noble Lords that back in 1973 and 1974 we were talking, as ever, about too much control by the centre. This has been a tension in British governance for many years. I see the Bill as an encouraging shift towards much greater local determination. I will come back to that shortly.

Although a number of noble Lords have expressed disappointment about the pace and scale of the greater responsibility that local authorities will have, we should not undermine the significance of what is in the Bill. My noble friend Lord Graham said that he was disappointed with the tone of some of the criticism. I hope that we will not get a thousand amendments, as he implied. It is clear that we will have a very engaged Committee stage and I will write to noble Lords on the points to which I will not be able to respond in a 20-minute wind-up speech.

Like other noble Lords, I pay great tribute to the noble Baroness, Lady Campbell, and the noble Lord, Lord Mawson. We are all agreed that their maiden speeches were splendid and we look forward to their continued involvement in this and other Bills.

I am ever sympathetic to the proposals of the noble Baroness, Lady Masham, on garden centres, although I fear that we will all spend even more money in them if she has her way.

My noble friends Lord Smith and Lady Jones spoke eloquently about the progress made by local authorities and the enabling nature of the legislation. I am sure that my noble friend Lady Jones was right when she talked about the need for local government to have more community engagement and citizen empowerment. Although being elected is very important in terms of local democracy, it should not end there. I commend to her the work of the Roberts commission in looking at ways to involve more people in local government. In my city of Birmingham, the Young People's Parliament engages young people in local government matters. There is much that we can build on.

I echo the words of the noble Lord, Lord Mawson, about the need for stronger partnerships between local authorities and community enterprises. I see that as very much part of the devolution package.

The noble Lord, Lord Bruce-Lockhart, talked about the progress that has been made by local authorities over the past few years. I agree with him. I also agree that we need to move away from an era of many central targets to one where there is much more local ownership by local authorities. That is what we are seeking to do in the revision and reform of the best-value regime. Although concerns have been expressed about the number of targets in the health service, I think that they are needed to get local government and the health service into the right place and to see the necessary improvements made. I doubt whether some of the improvements to which noble Lords have referred would have taken place without the central direction and targets. Having got there, I think that now is the time to move on, and the Bill is a very important statement of how we will do that.

Local area agreements, working with partners, the wider power of scrutiny, the requirement for partners to have regard to co-operate, comprehensive area assessments, less upward and more outward, and the 35 local improvement targets to be negotiated instead of being set in a top-down approach—all these go to the heart of what the Bill is about. The noble Lord, Lord Bruce-Lockhart, to whom I pay tribute, talked about the link between disadvantaged communities, poor educational and health outcomes and worklessness. He graphically described the power of this approach through local area agreements. I remember when he visited Ministers at the Department for Work and Pensions and we talked about the potential for a partnership between Jobcentre Plus and local authorities. If we can get the health service, the police and the other statutory agencies agreed on a local plan to look at disadvantaged communities or health issues, the power of that partnership could be enormous.

Surely the Bill's important message is that local authorities will be in the leadership position. Many noble Lords will know my father-in-law, John Stewart, a professor of local government who was in local government for many years. He used to talk about the enabling local authority. For me, this is what an enabling local authority is all about. It is concerned not just with running its own services and its own statutory provisions, but with taking the lead, working with other agencies and adding value to its local authority area and the people living in it. That is why I do not agree with the noble Viscount, Lord Eccles, and do agree with the noble Lord, Lord Best. I see this as a turning point towards devolution. I accept that it does not go the whole way, but it is a critical step.

This debate is largely about devolution; all noble Lords who have spoken have talked about its benefits. For most of the time I spend in this Chamber and as a Minister, people do not come to me and ask for devolution. The great thrust of our debate is about the need for central action. We have to address this because if devolution is to be meaningful, we all have to temper our approach to the demand for central government to take action. Central government action is not taken in a vacuum. We will shortly be debating the Mental Health Bill. The thrust of debate on that Bill has been about central direction and instruction to the health service locally. Getting the balance right between central direction and local determination is not easy. If we recognise that tension, we are much more likely to come to a satisfactory conclusion. Moving to a position of designated targets that are negotiated by the local authority, working with partners and with the Government, seems a way of balancing this tension.

The debate on two-tier local government was fascinating. My experience in Oxford was that, compared with being a county borough, being a second-tier local authority was not particularly satisfactory. I think that we were right to take a voluntary approach to structural change, but I accept, as the noble Lord, Lord Greaves, suggested, that where district councils are to continue, it is important that they are seen to have an important role and that they are recognised appropriately within the local area agreement and the partnership structures. That is what the Government are seeking to do.

Let me say to my noble friend Lord Dubs that, in terms of the broad cross-section of support, we recognise that proposals may not carry a consensus from or within all sectors. But authorities were asked to provide a range of support from key partners and stakeholders.

My noble friend Lord Clarke spoke about Burnley, and I understand the disappointment felt about the decision. The reason for it was laid out in the decision letters, to which I refer my noble friend. We have said that we have no plans for a further round of restructuring, which answers the point raised about stability. However, the Bill provides for a further invitation to councils to come forward with unitary proposals. There may, for example, be a case for inviting a council to make a proposal where that might be necessary to make sense of a boundary change. My noble friend was concerned about the primary care trust. There is nothing in the Bill that should jeopardise the very good work that he described early in his speech.

The Bill gives powers to move to whole-council elections. If a local authority was originally what is called a "partial council"—in other words, it elected members by half or by thirds—it will have the power to move back.

Voluntary organisations are not designated as statutory partners, because that would have the serious consequence of binding local authorities. It would burden them with a range of responsibilities that they may not want or be able to meet. I understand that we will come back to that matter in the future.

The scrutiny role gives to back-bench local authority councillors an enhanced and valuable function. I draw noble Lords' attention to the value of some of the OSC reports in the health service. They have been of high quality and enormously influential. They show us the way forward for local authorities. My noble friend Lord Smith spoke about the potential in this area. I have no doubts whatever, particularly in relation to health and social care, about the value of having those services around the table within the local area agreement and making them much more of an integral part of OSC responsibilities. It offers huge advantages for the future.

Perhaps I may offer to write to the noble Lord, Lord Roberts, about Wales. It is the Government's policy to draft Bills in a way that translates legislative competence to the National Assembly. This is an England and Wales Bill, so the provision for Wales is entirely appropriate. My understanding is that the Order in Council route will be taken where no suitable Bill is in the legislative programme. I understand also that the provisions were widely discussed and enjoyed cross-party support in the National Assembly, but I am happy to write to the noble Lord further on that matter.

The noble Lord, Lord Boston, made an eloquent point about freemen of the ports, to which I have no doubt we will return in Committee.

I turn to the health service. It is perhaps not surprising that noble Lords reminded me of my own heroic role in legislation on it. They will know that I started my career in the health service as a CHC secretary, but we were right to move on from CHCs. We can very kindly say of them that they had a patchy record. After 25, nearly 30, years, they had reached the end of the road. We saw patient forums as a way of moving on to match the agenda for the health service. I pay tribute to the work of those 4,000 to 5,000 dedicated people who have sat round the table of the patient forums and who frankly have not always had the support that they could have expected from the Commission for Patient and Public Involvement in Health. We should not run away from the fact that advice was given to some patient forums that names were confidential and could not be released because of data protection. Nor should we run away from the fact that advice was given to some patient forums that they should not meet on health service premises because that would be regarded as a conflict of interest. It has been absolutely right to move on.

We want to reflect the changes in the health service and in local government. That is the huge advantage that LINks brings. Noble Lords have not remarked on the fact that, for many years, CHCs wanted responsibility in social care. LINks gives that responsibility; it opens up opportunities for much more intensive monitoring by local people of the health and social care interface and for their showing concern for it. That will be an enormous advantage. We of course want to build on the work of patient forums and to encourage as many of their members as possible to take part in the new LINks. I say to the noble Lord, Lord Walton, and the noble Baroness, Lady Neuberger, that they of course have a huge role to play in enhancing and informing the commissioning role.

Many comments were made about the arrangements for a host organisation. I make no apology whatever that this is being done through local authorities. We cannot have it both ways. We have spent half this debate praising local government and the role that it wishes to take. In the other half, we have expressed doubts about whether local authorities should be given this responsibility. We should trust local authorities to do the job properly. Who is best able to ensure that the contract with host organisations is effective and is monitored, and that the money is handled successfully? I cannot think of a better way of doing it. It will be done by a local authority instead of a health service body to ensure that there is not a conflict of interest.

Since the resources that will be made available will be spent at local level rather than in a national or regional structure, which is what has happened with the Commission for Patient and Public Involvement in Health, the host organisation will be able to spend much more resource directly in support of the new LINks. I know that the noble Baroness, Lady Neuberger, disagrees, but providing relief from the responsibility for employment and all the other administrative duties, and having a local councillor voluntary service, for example, providing the support, will give tremendous support to those LINks. We hope that hundreds of people and many local organisations will come together to agree a governance structure.

Yes, it is true that I cannot answer some of the questions that were asked by noble Lords. That is because the whole point of what we are seeking to do is to give much more discretion at local level, which, again, is the very thing that noble Lords said that they wanted for local government in this debate. The whole process and the guidance that we will give will be informed by the nine early adopter sites that are now in operation. We will be informed by what is happening at the moment. That will inform the guidance, and that will ensure that we give as much discretion as possible. However, we can rely on local authorities, through the contract with host organisations and the guidance that we give, to ensure that due process is adopted.

There are many other points to which I would like to respond now, but we can cover them in Committee. I should like to turn to the issue of visiting. Why do we want co-ordination of visiting? We want it precisely because of the point raised by the noble Lord, Lord Walton, about the 58 organisations that have access, monitoring and visiting rights. On spot visits, my judgment is that that role must rest with the regulator. However, we will listen very carefully to what noble Lords have to say on this matter. The noble Baroness, Lady Neuberger, made a good point about the regulators perhaps using LINk members in some way. I shall certainly take that back to the regulatory bodies.

There is nothing sinister in making sure that consultation is significant. We are seeking to ensure that there is absolute clarity in the health service about what falls within the statutory consultation process and what does not. I am sure that we can share more on that in Committee.

I see no conflict whatever regarding foundation trusts. I am a member of the Birmingham mental health foundation trust and I hope to join the Birmingham LINk. I do not see a conflict here; the more people who can be involved, the better. For example, there is no reason at all why LINks should not decide to have a review of mixed-sex accommodation in the health service—a point raised by the noble Baroness, Lady Cumberlege—and issue a report on it to which the health service would have to respond.

We will have splendid debates in Committee and in stages beyond that. I shall write to noble Lords on the points that have not been answered in the debate. I thank all noble Lords who took part in this highly interesting and constructive debate.

On Question, Bill read a second time, and committed to a Committee of the Whole House.