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English Devolution and Community Empowerment Bill

My Lords, in proposing that Clause 53 should not stand part of the Bill, I should emphasise that I am not opposed to the clause—far from it. We have now had three debates about the role of local government in the health service, and I want to probe how far the Government are really prepared to devolve and delegate responsibilities for both health improvement and the NHS to strategic local authorities.

I will not repeat what has been said in our earlier debates, but this clause is very important. It makes consequential amendments to Section 18 of the Cities and Local Government Devolution Act 2016 to reflect changes introduced into this Bill. The importance of Section 16 is that it provides Ministers with the ability to confer public authority functions on local authorities, including health and social care.

The debate about the role for local authorities in relation to healthcare and health improvement is as old as the NHS itself. But since the 1974 reorganisation, it seems to me that the NHS and healthcare delivery has often stood remote and disconnected from the rest of public services such as social care, housing and education, which are under some kind of integration within local government and democratic control. I see devolution in health as a way to reconnect services, at least at a strategic level. I do not think this will happen without a stronger drive through powers devolved locally.

6.15 pm

The motivation behind the 2016 Act was, in essence, the then Chancellor of the Exchequer’s support for devo Manchester as a way to kick-start the economy in the north-west and hopefully set a pattern for the rest of the country. However, the legislation was passed, Mr Osborne left office, and the Whitehall appetite for devolution evaporated alongside his departure. Only Manchester benefited, in essence.

Earlier, the noble Baroness, Lady Scott, talked about the inability or unwillingness of the health sector to devolve money to local government. Last week, she talked about her own experience as a senior local government leader, about trying to go, as she described it, “to the full endgame”. She said:

“I tried to join the local director of children’s and adult care services with the local director of the NHS. I tried, but it did not work because health would not give up its power and its money

”.—[Official Report, 4/2/26; col. GC 612.]

That is a great pity, because the evidence from Greater Manchester shows that, although it is not perfect, it has made some real advances.

Research by Manchester University shows that the devolution deal enabled Greater Manchester to make significant improvements in many parts of the health system. For example, there were 11.1% fewer alcohol-related hospital admissions and 14.4% fewer hospital admissions for violence, same-day GP appointments increased and unplanned A&E reattendances were lower. The researchers argue that the positive changes

“are likely to have been a result of different aspects of the Greater Manchester devolution deals”,

such as

“the transfer of control over transformation funding … to the Greater Manchester Health and Social Care Partnership”.

My question to the Government is: given that the apparent possibilities for improvement are there, will they increase the powers of other parts of the country and extend health and NHS responsibilities to them? I am convinced that the NHS cannot be run under essential command-and-control management from the centre. I have tried it myself. The noble Lord, Lord Lansley, of course, had proposals; he tried through NHS England to move away from that but, as we have seen, that has proven to be very difficult indeed.

Clearly, there are concerns about how this works within the concept of a national service, where the public expect uniform provision throughout the country. But I have to say that I think Andy Burnham got it right. He has always talked about this, saying that you have to accept that the “what” has to be delivered with some basic standards that must be met and should be determined nationally, but how services are delivered and how a system becomes integrated to deliver the best overall package of services and set priorities is local, and it should be democratically local.

My noble friend Lady Taylor was encouraging in our debates last week, talking about local government having a bigger role in health. She reminded us that the mayoral competences set out in the Bill specifically include health, well-being and public service reform. She also spoke of her experiences in Stevenage, where she said they took a great interest in tackling some of the key health challenges in their area. I encourage her department to relook at the 2016 legislation, as it will be amended by the Bill, and give big encouragement both to its colleagues in the Department of Health and Social Care and to local government to enthusiastically embrace the health agenda. I am convinced that this is one way we will lead to better health outcomes.