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Lord Harris of Haringey: I am an enthusiastic supporter of the clause, because it provides an important means of strengthening the role of local government. Providing for scrutiny committees to look at the health services in an area adds to the range of oversight and scrutiny committees in local government and is a valuable part of building the community advocacy role of local government. That role is contained in proposals for local government, but this is the first tangible sign that it will affect and impinge on other public services.

I was slightly concerned about the contributions of both the noble Earl, Lord Howe, and the noble Lord, Lord Clement-Jones. I suspect that, so far as concerns

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this matter, they have not quite come to terms with some of the changes that are already taking place within local government.

The noble Earl, Lord Howe, suggested, for example, that councillors would not be able to take on such an onerous responsibility. I believe that he may not have recognised the enormous change that is occurring within local government. A distinction is now being drawn between the, perhaps, 10 members of a local authority who will sit on a cabinet and run the local authority by carrying out the executive, decision-making functions, and the role of the remaining--perhaps 50--members of a local authority, who will be involved in scrutiny arrangements. Not only will they be concerned with what their own local authority's executive--the cabinet--is doing; they will also have responsibility for reviewing and taking a policy view of what is happening elsewhere in their area. They will act as genuine local representatives. That change in the role of most local councillors will represent a valuable part of the work that they do. It will not be squeezed out by executive responsibilities because the nature of local government work has changed.

Similarly, the noble Lord, Lord Clement-Jones, conjured up a fantasy that overview and scrutiny committees would be dominated by the party whip system. I appreciate that he is probably not as steeped in the rules of the Labour Party as I am. The Labour Party has adopted rules which state clearly that it is not possible to whip councillors who sit on scrutiny committees. He may be telling us that the Liberal Democrats or, for that matter, the Conservative Party allow rampant whipping to take place on scrutiny committees and that, therefore, they distort the whole operation. However, if all the major parties took the view, as the Labour Party has done, that it is not appropriate for whipping to take place, that issue would not be so serious.

Having said that, I believe that, by and large, the Government should consider seriously the amendments that have been put forward. There are risks in relation to scrutiny of the health service by local government. One such risk is that the process could be extremely antagonistic, with local authority councillors spending their time effectively attacking what takes place in the local health service and pursuing matters in relation to closures, cleanliness, waiting times, or whatever, to the exclusion of the wider picture.

That is why I believe that the amendment in the name of the noble Lord, Lord Clement-Jones, which seeks to ensure that part of the scrutiny process involves the consideration of health improvement programmes, and so on, and the strategy required in that respect, is sensible. It seeks to ensure that discussions held by scrutiny bodies are focused on the wider picture and do not become antagonistic.

I believe that an approach which ensures that scrutiny committees listen to the viewpoints expressed by other agencies and call evidence--perhaps in the same way as parliamentary Select Committees are able to do--will make certain that the relationship between

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local authority scrutiny committees and the local health service is constructive rather than antagonistic. We should certainly all be working towards that. Therefore, I hope that my noble friend will consider the amendments carefully and ensure that the spirit behind them is embodied in the final legislation.

The Earl of Listowel: I also welcome the amendments in the name of the noble Lord, Lord Clement-Jones, and I welcome the extra patient focus that the Government are introducing. Recently, at a Centrepoint conference, two young, homeless 20 year-olds made a presentation. What they said was far more powerful and constructive than anything said by any other contributor, including chief executives and the local mayor.

In his opening remarks, the noble Earl, Lord Howe, made clear that a balance needs to be struck between individual representation and the whole picture or the whole community. Therefore, I am concerned about what will happen to the former function of CHCs, which, to a large extent, involved reaching out to the local community and looking out for local health needs.

Therefore, I welcome the amendment and would appreciate some reassurance in the Minister's response as to how proactive the replacement for CHCs will be in reaching socially excluded groups. As an example of what CHCs have achieved in the past, perhaps I may quote from a newsletter:

    "Health Action for Homeless People has had a long association with Community Health Councils. They were instrumental in establishing the organisation and managing it for many years. London CHCs in particular have an understanding of the difficulties experienced by homeless people in accessing good health care and are effective in lobbying for improved access and for good quality specialist services".

Perhaps I may give another example. At a recent meeting of the All-Party Parliamentary Group on Maternity, its members heard about research currently taking place in Islington. That research indicates that a surprisingly large number of single mothers are living in temporary accommodation and that they have very few friends. They have no contact with one another. There may well be a need for a health initiative in relation to that situation. Perhaps a local centre is required to bring the mothers together, or something along those lines. Again, I hope that the Minister will address those concerns in his response.

6.15 p.m.

Lord Hunt of Kings Heath: This large group of amendments probes the functions of local authority overview and scrutiny committees. Perhaps I may refer to the original question raised by the noble Earl, Lord Howe. He asked what we are trying to achieve. First, as my noble friend Lord Harris said, such committees are a recognition of the leadership, or advocacy, role which local authorities play in the community. In addition, their establishment recognises that the National Health Service is an important part of any local community. It is absolutely right that local authorities should wish to take a view on the progress

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and key decisions of the National Health Service. I believe that the committees will lead to an enhanced relationship between the NHS and local government.

Over the past 10 or 20 years we have seen the problems that arise when the NHS and local government do not work well together. In recent years, there has been a tremendous improvement in that relationship. In the winter planning undertaken over the past few months, local authorities have been absolutely vital partners in the planning and provision of services. The enthusiasm with which they took part in discussions with the NHS at local level showed a much more positive relationship than there has been for many years.

I understand the concern expressed by the noble Earl, Lord Howe, that that relationship may become adversarial and destroy the good work that has taken place. However, I believe that the scrutiny committees will lead to local authorities having a greater understanding of the issues and priorities faced in the health service. I believe that, just as importantly, they will help the NHS to understand local authorities' core issues of concern which affect the whole community.

From discussions that I have held with members of many local authorities, I understand that they welcome the proposed new role. They believe that they will have the capacity to undertake it, and they will use it as a constructive approach towards better relationships with the NHS overall.

In response to a number of amendments, perhaps I may reiterate that I believe that, in time, the committees will develop an expertise which will add value to the process of NHS scrutiny. We are providing a new function for an existing body. Therefore, the overview and scrutiny committees will continue to be bound by the procedural requirements set out in local government legislation, which is a part of the local authority's responsibility. That is why making the power in Amendments Nos. 51 and 52 is unnecessary. They will also draw on their existing resource arrangements for the funding of those OSCs.

We expect the OSCs to have a wide-ranging role and to take their own decisions as to the key areas for scrutiny in their local areas. We also intend the OSCs to have real teeth. Therefore, I should say to the noble Earl, Lord Howe, that the function of referring contested service change proposals to the Secretary of State by an independent reconfiguration panel, currently with CHCs, which will pass to OSCs, will be a very important indicator of the importance of the scrutiny committees.

Clearly there will be other matters which do not come within the definition of a contested service change. But it would seem to me unlikely that the local NHS would not take account of the views expressed by the OSC on a whole range of matters.

I certainly accept that the OSCs cannot operate in a vacuum. They will have shared interests with patients' forums and patients' councils. We expect those bodies to work together locally. But it is important that we recognise that they have different functions. The OSCs are there to represent the interests of the public.

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Patients' forums and councils are set up to have a specific patient focus. Both perspectives are important but they are different and there is a risk of mixing the two so that one becomes drawn into--I use the noble Earl's expression--a mish-mash. It is extremely important that we clarify and separate those different roles. That is why we do not agree with the suggestion that OSCs, patients' forums and councils should be obliged to share members or that there should be formal partnership arrangements.

I have mentioned already that we want OSCs to develop their own priorities for scrutiny. I certainly agree with the noble Lord, Lord Clement-Jones, that the local HImP and actions to address health inequalities are likely to be high on the agenda. Amendments Nos. 37 and 53 would provide specific powers to allow the Secretary of State to require OSCs to look at those issues.

I do not believe that those amendments are necessary. Those issues relate to the health service. The current regulation-making powers in the Bill would enable the Secretary of State to provide that such issues are considered. I for one should very much welcome OSCs focusing on those issues because if we are talking about health inequalities, we shall certainly not achieve all we wish to achieve unless health and local government are working together.

I turn now to the issue raised by the noble Lord, Lord Peyton, who is no longer in his place, to which the noble Earl referred; namely, the risk of tying up the NHS in bureaucracy in responding to the information requirements or the summoning of NHS officials before the OSCs.

I understand Amendment No. 43. We anticipate requiring NHS chief executives to appear before the OSC once or twice a year. That is a reasonable requirement. We do not believe that we need further protection on the face of the Bill. I should much prefer to leave this matter to the good sense of people locally to operate sensibly. I really believe that the great majority of local authorities will behave sensibly and will call NHS officials before them when that seems appropriate but will not over-egg that and cause a huge bureaucratic burden for them.

It is worth saying that OSCs are developing ground in local government. Experience so far shows them to be effective. And so councils will not be coming to this with a fresh piece of paper. They will have had experience in operating the system.

Our proposal to make local social services authorities the lead on NHS scrutiny will certainly help to ensure effective and consistent scrutiny and will reduce the number of OSCs directly scrutinising the NHS.

I do not agree with Amendment No. 38, which would give all district councils scrutiny rights. There is a part for district councils to play in NHS scrutiny and the provisions in Clause 8 allow that to happen. But if each of the large shire counties with a large number of non-metropolitan district councils had scrutiny powers as of right, there would then indeed be the bureaucratic problem to which the noble Earl referred.

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We believe that the OSCs should look at all services, including those delivered in partnership with the local authority. I know that some Members of the Committee have expressed concern about that but it is worth making the point that within the OSC role within local government, that happens now in relation to scrutiny by the committee of local authority directly provided services. On those grounds, I would not support Amendment No. 56.

Amendments Nos. 46, 49 and 52 deal with the powers of OSCs to call for inquiries or involve CHI, the Audit Commission or the Secretary of State. As regards inquiries, I do not believe that it is necessary for the OSCs to be able to call inquiries, particularly not with powers to summon evidence. That would be a power on a par with that of the Secretary of State under Section 84 of the National Health Act 1977. The Bristol inquiry is an example of the use of that power. It seems to me that that is going too far. But, of course, OSCs have every right to decide what issues to look into and the right to ask people to come to give evidence.

On the submission of OSC reports and concerns to other bodies, if it is unhappy with the way that the local NHS has responded to it, the OSC will be able to refer its concerns to the Secretary of State or the regional office. I confirm also that the Commission for Health Improvement is already empowered to investigate concerns raised by other bodies so that no new powers are needed to allow CHI to respond to requests from an OSC. Therefore, those amendments are unnecessary.

Amendment No. 41 seeks to change "may" to "shall". That would mean that the regulations on OSCs would have to make provision for all the matters set out in paragraphs (a) to (f). It may not always be appropriate, over time, to make provisions on some of those matters. In addition, the extent to which the Secretary of State would have to make such provision is unclear. So I firmly come down on the side of "may" in this debate.

However, I assure the Committee that it is our firm intention to make regulations to define fully the role of OSCs, as it is clear that regulations must be made if the scheme is to operate properly.

As regards taking account of the views of those who have an interest, we shall consider and welcome any views given to us by relevant organisations, such as the Local Government Association, before making the appropriate regulations.

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