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Lord Smith of Leigh: Perhaps I may seek clarification on some of my noble friend's comments. While I agree with him that overview and scrutiny committees should help to strengthen the relationship between the NHS and local authorities, they should not be seen as replacing relationships which exist already between the executives of local authorities and the NHS. Those bodies deal with those matters on which my noble friend commented; for example, the problems in relation to winter planning. They will also

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help to develop the care trusts and so on. As my noble friend knows, in my own authority there is a well-established health partnership board which involves ourselves, the local NHS trust and the health authority. Indeed, I had to tender my apologies in relation to that today in order to attend your Lordships' Committee.

6.30 p.m.

Lord Hunt of Kings Heath: Perhaps I can respond to my noble friend. I agree with the point. I was simply trying to say that I believed that overview and scrutiny committees would be but one aspect of the developing local government/NHS relationship. I certainly accept that, in terms of ensuring that collaboration and the provision of services works, including the involvement of the local authority in major NHS strategic change, the role of the executive of the local authority would be important.

Baroness Cumberlege: Much of this has merit. I understand the democratic deficit argument that has taken place for decades. Where the overview and scrutiny committees are good they will be very good; but where they are bad they will be perfectly horrid. Where there is a danger that the OSCs become a griper's charter, where they do nothing positive at all, but in fact destroy the trust and the good relationships that have built up, what action can be taken? Secondly, how will the committees be judged in relation to their performance? What criteria will be set against which they can be judged?

Lord Hunt of Kings Heath: That must be a matter for the local authority concerned because that will be part of the scrutiny role of the local authority. The scrutiny committee will not operate on its own, but it will operate alongside a number of other scrutiny committees. I would expect the local authority--as it will when it reviews the performance of the scrutiny committees from time to time--to monitor, to review and to take account of any views that the NHS may express when considering whether any changes need to be made.

On the issue of areas where the relationship is difficult, I do not want to dwell on that too much because I am positive about the developing NHS/local government relationship. I believe that it has changed fundamentally in the past few years. Now it is rare to find a place where the relationship is as bad as those to which the noble Baroness has referred. I also believe that it takes two to tango. It is not just a matter of a local authority being excessive in its demands; it is also a matter of the NHS being prepared to share information, time and officials with the scrutiny committee to take that committee through the issues that they are debating. At the end of the day, I believe that ensuring that that works out as effectively as possible should be left to the local level.

Earl Howe: Before the noble Lord, Lord Clement-Jones, responds perhaps I could ask the Minister about the purview of an overview and scrutiny

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committee. The lines on a map that delineate the boundaries of health authorities do not always reflect real life. Will a local authority overview and scrutiny committee have powers to examine proposed health service changes in adjacent local authority areas if such proposals are thought likely to have an impact locally?

Lord Hunt of Kings Heath: I would expect the focus of the OSC to be related to services provided within its boundaries. I accept that the NHS does not necessarily organise itself around local authority boundaries; sometimes perversely hospitals are built just within a borough boundary, and London has classic examples of that. That is why in Clause 8 we allow for regulations to make provisions for two or more local authorities to appoint a joint committee. Through those arrangements we shall be able to deal with issues such as a hospital that is on one side of a boundary providing services to those on the other side of the boundary. We would hope to deal with the general principles through regulations, but much will come down to good common sense as well.

Lord Clement-Jones: I thank the Minister for his response to this set of amendments. The noble Lord, Lord Harris of Haringey, lowered the tone of the debate by referring to "rampant whipping" and I confess that despite having lived in Lambeth for 30 years I had not realised what pussycats the Labour Chief Whips have become under the new regime!

The noble Lord, Lord Harris, made an important point that we need to design into this set of proposals the opportunity for constructive discussion between the NHS and local government. I believe that that is the cardinal aim set out by the Minister. He referred to enhancing the relationship between the NHS and local government, that the scrutiny committees would have real teeth and that they will not operate in a vacuum.

Since 1974 there has probably been a democratic deficit in the health service that requires amendment. As I said earlier, we have suspended disbelief in relation to this matter, but if these proposals go some way towards curing that democratic deficit, they should be welcomed. The Minister was extremely tentative in his approach to some of the amendments, which is to be regretted. In some areas he was a little vague; for instance, on the ability to scrutinise health improvement plans and health improvement strategies--they were welcomed by the noble Lord, Lord Harris--which I believe would be a cardinal function, he said that the Secretary of State would have power to require overview and scrutiny committees to do so and that he, as a Minister, would welcome a focus on those issues by OSCs. To me that did not quite add up to the Minister saying, "Yes, we will definitely place a duty on and give a power to OSCs to do so". A little more clarification from the Minister would be helpful.

Lord Hunt of Kings Heath: I do not believe that there is any doubt at all that the OSCs will have the ability

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to question the local health service about HImPs and their future strategies. That is the whole purpose of the committees.

Lord Clement-Jones: I assume from that that the Minister is saying that the Secretary of State will make regulations that allow them to do so and to have that as a principal part of their duties. In the Bill as currently drafted, that does not spring from the page.

Another aspect is that as we go through the Bill clause by clause at one point the Minister is a great centraliser and at another point he becomes the great decentraliser, except in relation to district councils: "We are the great decentraliser; this is the way we do things; we devolve to the lowest point and when it comes to representation it goes to patients' forums which are at the right level, close to the patient, close to the public and close to the NHS trusts and so on. But when it comes to scrutiny, I am very sorry that the ordinary district or borough council is not to be allowed anywhere near this set of proposals". On that point the Minister's response was not particularly adequate.

Lord Hunt of Kings Heath: I am grateful to the noble Lord for giving way. My first experience as a member of a local authority was in Oxford, in a non-metropolitan district council. I understand why non-metropolitan district councils would want to be scrutiny committees in their own right, but perhaps I can take Kent as an example. Kent has a population of 1.3 million; it comprises 12 district councils and one unitary authority. With the best will in the world, unless the principal local authority--the social services authority--is the OSC, one would run into the kind of bureaucratic issues that have been raised by noble Lords in Committee.

Of course, there will be an ability for the county council scrutiny committee to co-opt a member of a district council; it will also be able to delegate its roles perhaps in relation to a particularly local service. However, in practical terms, I believe that it will be difficult to allow the amendment.

Lord Clement-Jones: I thank the Minister for that extra elucidation, which was genuinely helpful. Although we found his response more unhelpful than we originally anticipated, having heard it I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

The Deputy Chairman of Committees (Lord Geddes): I must advise the Committee that if Amendment No. 38 is agreed to I cannot call Amendment No. 39.

[Amendment No. 38 not moved.]

Lord Clement-Jones moved Amendment No. 39:

    Page 6, line 25, at end insert--

"( ) the GLA"

The noble Lord said: Fuller amendments on a similar theme remain to be discussed in this group. In the light of the experience of Members of the

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Committee who have tabled them, I know that they will be most interesting and I shall therefore be brief in introducing Amendment No. 39. It is tabled in order to draw the attention of the Committee to a major gap in the provisions.

We debated the GLA Bill at some length. Although it was not as full as it might have been as regards the duties of the authority to have responsibility for certain public health matters, as a result of work carried out by the King's Fund and other bodies, it was possible for the other place to insert provisions relating to the GLA's assessment of its health policies on the capital. It seems to us on these Benches and to many organisations involved in health in London that the position of the GLA must be recognised to a greater extent.

Indeed, one could draw a parallel much more broadly. The future role of regional government should be recognised. After all, the GLA is a strategic body and such health scrutiny is precisely the kind of activity it should be carrying out. Unless it is brought into the net--and I speak as a Londoner--London will be the poorer and we shall not have the precedent that we should have for future regional government. I beg to move.

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