Health Bill [HL]

Amendment 11 brings to the attention of the Committee a substantial omission within the constitution, the handbook and the statement of accountability, which is the requirement of NHS bodies to review and consult with local government on their local accountability arrangements. Despite the long list of bodies referred to by the noble Lord, Lord Warner, in a previous group of amendments, the NHS remains largely unaccountable to local people, not least because strategic health authorities bear no relation to any other tier of government. Pretty well the only means of accountability lies within local health overview and scrutiny committees. They have the power to scrutinise the operation and planning of local health services, and they can make reports and recommendations on the adequacy of current planning and provision. Strategic health authorities struggle to achieve the level of interaction and joint agreement with the NHS that perhaps was envisaged for them when they were created. It is relevant to point out that in the research done in 2007 fewer than 10 per cent of non-executive directors of health trusts were local councillors. That is not in itself a bad thing, and we have no desire to return to the old days when local health boards had large numbers of political appointees placed on them. However, it points to a degree of separation between local authority planning and local NHS planning, which I think will become more noticeable over the coming years. It is something that comes to the fore when resources are scarce. Why is this important? Not for the first time, politicians of all parties have been coming to a realisation that not just the use of public funds but the way in which public services are designed and implemented locally have an impact on the health of an area, and we are beginning to understand in ever greater detail the effect that environmental decisions can have on the health of a population. The planning of roads and social facilities, the location of schools and access to healthy food within communities are becoming more relevant and important. There should be a greater degree of sharing between the NHS and local authorities if there are to be improved health outcomes for local populations and if health inequalities are to be reduced. It is perhaps in the realisation that the current system of health overview and scrutiny committees, notwithstanding the time and effort that local authorities put into it, does not work to the satisfaction of everyone and could be a great deal better. At this moment when the Minister has put forward this document, which is I suppose a statement in time with aspirations for the future about how we are to improve the value of the NHS to health within local communities, this requirement to share on a more equal basis with local authorities the mechanisms for accountability should not be overly bureaucratic. People in the NHS should not be fearful of it, it is just one way of being more effective stewards of resources that may not diminish, but will be in increasing demand. That is why we have tabled this amendment in this way and I hope that the Minister will find it acceptable. I beg to move.