Health Bill [HL]

Amendment 11 would require all NHS bodies, including foundation trusts and special health authorities, Monitor and the Care Quality Commission to consult their local authority every year on the adequacy of their local accountability through their local councillors. I agree with the sentiment that it is vital for the NHS to engage with its local populations and with its key partners, such as local authorities. However, I do not believe that it is necessary to place such a requirement on the NHS. We have already introduced a comprehensive framework of policies, which I shall go through, to strengthen the accountability of the NHS. This includes giving councils the power to review and scrutinise local health services; introducing foundation trusts, with their membership systems; putting a legal duty on the NHS to involve local people in its decisions about services; and introducing local involvement networks. These reforms are backed up by the world-class commissioning programme, which holds primary care trusts to account for their performance, including how well they engage with their local population. I distinctly remember the debate on this over the year when we put the constitution together. It is interesting to see my noble friend Lady Jay here, as she was also a member of a think tank as part of the King’s Fund, which was looking at the accountability of the NHS. It debated in significant breadth what the best model was. The statement on NHS accountability, which was published alongside the NHS Constitution, shows that there are a number of ways in which PCTs are free to adopt local views, and I shall go through them again. They include: inviting local councillors or mayors on to their boards; increasing the integration of commissioned services through joint planning arrangements—there are numerous examples of joint commissioning; it is working well and we have seen the fruits of it; creating a local membership system; joint appointments of senior executives; formal partnership arrangements; and pooled budgets, which we will talk about in due course. As the noble Baroness, Lady Barker, said, it is also critical that the public know how the NHS is accountable at a local level and how they can get involved in the accountability structure. That is why we set out very clearly some of the mechanisms that I described in the statement of NHS accountability, which, as I said, was published alongside the constitution. This is a public-facing document which explains roles, responsibilities and accountability in the NHS. I think I have demonstrated that there is already an extensive system of local accountability in the NHS, and the NHS is of course always working to improve the way in which it involves local populations and works with local authorities. It is also not the case that the only mechanism for local accountability is through local councillors. I hope that I have reassured the noble Baroness that over the past year we have worked to improve the framework of accountability and that she is able to withdraw her amendment.