Local Government and Public Involvement in Health Bill

The noble Lord is arguing that NHS trusts and foundation trusts should be named as partners for all responsible authorities in which they provide services to ““a significant proportion”” of residents rather than only to the responsible authorities in whose areas they have facilities. The reasoning behind the amendment is that the services provided by the trusts may indeed have catchments that go beyond local authority boundaries, as the noble Lord has explained, and some trusts would not therefore have to co-operate with the responsible local authorities in which they provide services but do not happen to have facilities. In the light of the noble Lord's comments, the debate on the previous amendment and the comments of the noble Baroness, Lady Hamwee, that we seem to be over-complicating matters and doing a lot of things of which they do not approve, it is interesting to note that implementation of this amendment would be very complicated indeed. For reasons that I shall explain, it would have serious unintended practical consequences. When we added NHS trusts and NHS foundation trusts to the list of partner authorities in another place in recognition of the role they play in delivering local priorities well beyond health, we made it clear that we did not wish to place on them or on the responsible local authorities any unnecessary burdens or confusions that might be brought about by the nature of many of the trusts. For that reason, we have required that only the trusts that operate a facility within the boundaries of the authority must be a partner. We have described this as the Great Ormond Street Hospital problem. Trusts such as Great Ormond Street deliver specialist services across the country at a regional and even national level rather than to one specific local place. We do not wish to place on Great Ormond Street a burdensome requirement to co-operate with all the responsible local authorities in the country. That is just what the amendment would do. I can see that it attempts to limit the number of responsible local authorities with which each trust must co-operate by the notion of ““significant proportion””, but that is too ill defined to work in practice. Great Ormond Street delivers specialist children’s services across the country. Clearly children and their families will make up a ““significant proportion”” of residents in each area who may at some point require Great Ormond Street to provide them with specialist services. So by that definition it would have to co-operate with every responsible local authority. I support the notion that where the catchment area of a trust clearly goes beyond the boundary of the responsible local authority in which it has facilities, we should encourage—and we will do so in guidance—local decision makers to consider how the neighbouring authority should co-operate with it, a discretion which they enjoy through Clause 108(2)(a)(ii). As I said, we will set that out in guidance. I urge the noble Lord to think about the amendment’s implications. They would be very serious for the large specialist and third-tier hospitals.