Health Bill [HL]

I thank noble Lords for their contributions to this debate. I start by assuring the noble Lord, Lord Walton, that it was not my intention in any way to reinvent the horrors of the 1970s, reconstituting effective bodies and replacing them with wholly ineffective ones. I had hoped that we were talking about something that reflected more the lessons of the past 30 years. I absolutely do not underestimate how difficult it is to get the NHS and social care to work together effectively. Some people in both areas have spent their entire professional lives trying to make that happen with varying degrees of success, and some of them bear the scars. I certainly was not trying to advocate any kind of situation in which local councillors would be allowed to dominate health decisions. That would not be right. However, over the past 30 years we have come to recognise that for effective planning of health and social care services all sorts of people with professional knowledge—and, thinking about housing, in some cases technical knowledge—need to be involved on an equal basis in discussions with the policymakers. I should like to ask the noble Lord, Lord Darzi, one question, although I do not expect him to come up with an answer instantly. How many PCTs invite councillors to be on their boards? I understand that there are examples of good practice but I should like to know how prevalent it is and how it works to good effect. I accept some of the criticisms about some of the wording in the amendment. It was not an attempt on our part to say that local councillors are the only mechanism for local accountability; none the less, they are a pretty important one. I say to the noble Baroness, Lady Young of Old Scone, that we have had comprehensive area assessments for a long time and they have included health. These have recognised that we have had a health oversight and scrutiny committee but that it has not worked, so we need to move a bit further. I have long thought that one of the big problems in the NHS is that strategic health authorities do not relate to any other part of Government. Nevertheless, they exist and I accept that there is no appetite whatever anywhere in the NHS for a restructuring; you have to go with the structure as it is. For all the flaws in the amendment’s wording, I was trying to dig out the fact that where health oversight and scrutiny committees see things going wrong and that the NHS is not having the impact that it should, they do not have a mechanism at the moment to influence strategic health authorities. That is a major gap. If strategic health authorities are to continue to have responsibility for the performance of PCTs, there has to be an alignment with social care. I take entirely the point of the noble Baroness, Lady Cumberlege, that in social services people work to structures and that in the NHS they work to relationships. Happily, sometimes they come together—it is purely chance if they do—and when they do it is spectacularly creative. However, for quite a lot of the time it is not. There is a reason for introducing this provision now. I can remember that slightly more than 10 years ago, when resources were tight, social care and health services used to bat patients back and forward in order not to pick up responsibility for equipment, drugs or care. That kind of thing happens when money is tight. It is not yet tight, but it might be. If we can see a deficit—not in places for people to go and play at being local politicians—in the understanding of users of health and social care services of how the resources are being used in their area, addressing that situation now would be very wise. I have listened to the Minister and to the comments made by other noble Lords about the deficiency of the wording. I shall take the amendment away but I may wish to return to the issue in some respects. I beg leave to withdraw the amendment. Amendment 11 withdrawn. Amendment 12 not moved.