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Lord Smith of Leigh: In speaking to Amendment No. 58, I want to add to what was said by the noble Lord, Lord Clement-Jones, about the missing elements in the Bill. I welcome in principle the fact that Clauses 7 and 8 increase local authorities' accountability for the health of local people. However, at regional level in England, particularly in London, that element is missing in various proposals.

As the noble Earl, Lord Howe, said, issues relating to health do not fit neatly into the boundaries of local authorities, either singly or collectively, effectively to organise scrutiny. For example, public health for the region; the work of the regional health authorities; tertiary care provision; and health performance indicators, both inter-regional and intra-regional, could be subject to scrutiny by bodies at the level of the region.

Throughout England, there are in existence organisations which are capable of handling such matters. They are the regional assemblies and chambers which exist in all regions throughout England. They are selections of local authorities and other key social partners.

Unfortunately, the Department of Health does not always recognise the way in which the regional agenda is moving in England. On Friday, I attended a seminar held at the DETR examining the way in which the regional agenda is developing. All the key departments of state were represented, with the exception of the Department of Health. Even the Treasury was represented.

Health has a major role to play at the regional level in driving policy forward. I commend to my noble friend the social inclusion policies, which are most important for the Government, and also regional

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economic development. We need to get the health of people right. In my area, levels of unemployment may not be as high as they once were, but the level of incapacity is exceedingly high.

The work of the regional assemblies and chambers is being recognised by other parts of the Government. The Deputy Prime Minister and the Chancellor attended a meeting in Middlesborough on Friday 9th March. The Chancellor then said that he was making £5 million of new resources available to regional chambers to help them establish a substantially expanded scrutiny role within regions. He deliberately did not say that that was to be scrutiny only by the RDAs but left it open for them to examine across the region issues which matter to that region.

Regional assemblies are on the agenda. They have the means and the ability to effect scrutiny at the regional level and I hope that my noble friend will consider that most carefully.

6.45 p.m.

Lord Harris of Haringey: I want to speak to Amendment No. 65 standing in my name. I declare an interest as a member of the Greater London Assembly. The amendment is designed to rectify what I can only assume to be a mental aberration by civil servants in failing to recognise the existence of London. Recognition is given to the City of London, which has its own special clause, but the other 7 million people in London might wonder why no arrangements within the Bill would permit the London Assembly to take part in the overview and scrutiny arrangements in respect of London's health services.

We may be told by my noble friend the Minister that that is not a problem because the London Assembly's terms of reference are so broad. However, I am concerned that it is not made clear in the Bill that the London Assembly has a role in respect of the scrutiny of London's health services. Part of that role must be fulfilled in collaboration with the London boroughs and I can see circumstances in which provisions for joint committees of local authorities to scrutinise pan-London health issues will not involve the London Assembly because it is not included on the face of the Bill.

In referring to a particular anomaly, I should declare an interest as a non-executive member of the trust board for the London Ambulance Service. Such trusts are responsible for delivering pan-London services. I understand that twice a year the chief executive of the London Ambulance Service might be required to attend meetings of the overview and scrutiny committees of all 32 London boroughs and of the Corporation of the City of London, perhaps making some 66 visits to such committees. Given that he has an extremely busy role, that is not necessarily the best use of his time.

The most sensible outcome would be for the Bill to reflect clearly the role of the London Assembly; to reflect the fact that the most appropriate scrutiny body for the London Ambulance Service and any other pan-London service will be the London Assembly; and to

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ensure that the provisions of the Bill cover that. I am sure that the amendment tabled by the noble Lord, Lord Clement-Jones, has the benefit of simplicity but I suspect that it is technically flawed. I suspect that my attempt, which is rather more verbose, is also technically flawed. However, I hope that my noble friend will assure the Committee that at a later stage he will bring forward proposals which will cover London and the role of the London Assembly.

Lord Hunt of Kings Heath: I am grateful to both my noble friends and the noble Lord, Lord Clement-Jones, for raising an interesting question. I recognise the role of the GLA and the regional assemblies and chambers and I am encouraged by their interest in healthcare issues in the wider sense. I am responsible for the eastern and north-western regions of the health service and I encourage both chairs to become involved in the regional chambers. It is very important that regional chambers understand, for example, the effect of the NHS on the regional economy which can be quite profound. I begin by being positive about constructive relationships at that level.

There are two issues in the context of the Bill. Clearly, we are endeavouring to promote scrutiny at local level, because in the end it is the connection between the health service and local services which has more impact on the quality of the services to the patient and the public. That is why in terms of scrutiny of the NHS we have made local social services the lead authority. I believe that the case for that is as strong in relation to whatever be the regional structure as in relation to the issue raised earlier by the noble Lord, Lord Clement-Jones, who referred to district councils. We need clarity.

I am convinced that the principal local authority which accepts the role of scrutiny should be the local social services authority, but I accept that there are circumstances in which scrutiny on a regional basis is appropriate. The powers in Clause 8 of the Bill enable that to happen through a joint committee of the OSC with NHS scrutiny right across the region. I believe that that approach provides a practical basis for working with the GLA without taking any further powers. I am wary of further powers which in the end make unclear who is responsible for scrutiny of the NHS. I believe that to provide powers to the GLA or regional assemblies on the face of the Bill could lead to confusion of scrutiny responsibilities unless there is clarity as to which authority is absolutely responsible. The Bill already provides for joint committees and will enable a pan-London committee to be established with co-opted GLA members.

I accept the point made by my noble friend Lord Harris that we want to avoid the need for the chief executive of the London Ambulance Service Trust to make 66 visits. We want a sensible arrangement and we believe that the Bill allows for that. I point out to my noble friend that officials of the department are working with the GLA to develop a protocol about the involvement of the GLA in the development of London-wide health strategies. I should be very happy to meet my noble friend to discuss that further.

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It is very difficult to accept Amendments Nos. 141 to 143 because it is our policy that CHCs should be abolished. On that basis, those amendments fall.

Lord Harris of Haringey: Can my noble friend clarify how Clause 8 applies to the London Assembly?

Lord Hunt of Kings Heath: In a number of ways. Clause 8(2)(a) provides that,

    "two or more local authorities may appoint a joint committee of those authorities".

Therefore, it would be possible for the London boroughs to come together to organise a joint committee and for co-options to take place.

Lord Harris of Haringey: First, does my noble friend suggest that Clause 8(2) operates on the basis that the Greater London Authority is a local authority, which on occasions is subject to some doubt? Secondly, can the Committee be clear that Clause 8(2) does not require the operation of subsection (1) as far as concerns the GLA? Clearly, that authority cannot fall within the purview of Clause 8(1) because it does not have executive arrangements under Part II of the Local Government Act.

Lord Hunt of Kings Heath: I said to my noble friend that I was very happy to meet him to discuss this further, particularly in the light of the protocol arrangement that we wish the Department of Health to develop with the GLA. Clause 8(2) makes provision for two or more local authorities--which I take to mean London boroughs--to appoint a joint committee, but it would be open to that joint committee to co-opt members from the GLA.

Lord Smith of Leigh: Is the Minister saying that Clause 8(2)(a) applies also to the regions outside London?

Lord Hunt of Kings Heath: I require a little more persuading of that. The specific case raised by my noble friend Lord Harris related to the area of the London Ambulance Service which, if not coterminous with the GLA boundary, is fairly close to it. If one looked at other regional assemblies one might find it difficult to identify a service which neatly fitted into the regional boundary. I want the NHS and regional chambers and assemblies to have a close working relationship and I am very happy to discuss that further with my noble friend.

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