Health and Social Care Bill

My Lords, I will speak to my Amendment 238H, as well as amendments moved by other noble Lords. I am pleased to confirm that the Opposition entirely support the amendments moved by the noble Lord, Lord Ramsbotham, the noble Baroness, Lady Massey, and the noble Lord, Lord Shipley. Once again, I am pleased to say that Newcastle is united on the issue of the composition of health and well-being boards. The only amendment about which I have not so much a reservation as a question is that to be moved by the Minister, Amendment 239, which refers to the possibility of a local authority giving permission to the health and well-being board to carry out, "““other functions of the authority””." I wonder whether the Government have borne in mind the fact that there is now a general power of competence for local government, and whether it is the intention of this amendment to embrace not only the statutory functions of local government as things that may be delegated to the health and well-being boards but anything that the local authority is empowered to do. Given that there is now a general power of competence, that would be a very wide remit indeed. It is not necessarily a wrong line to take but it would be interesting to know whether the Government have considered that potential implication, and if they have not—and I would not blame the Minister if he had other, more pressing things on his mind—perhaps he might come back to us at Third Reading or before. I particularly welcome the amendments moved by the noble Lord, Lord Ramsbotham, because they raise the issue of children's services and health, which has to a significant extent been overtaken in this Bill by other considerations around traditional health services and adult care. I very much welcome those points. In relation to the amendments moved by the noble Lord, Lord Shipley, I join him in thinking that it would be very helpful for the Government to send a signal as to the representation of elected members— not merely one, who could be regarded as a token, but a significant number. I would have gone perhaps slightly higher than three, but three would be a working basis. In Committee, the Minister said that it is up to councils to decide the composition of these boards. That is true, but I think a signal would be welcome in that respect. I am particularly glad to join the noble Lord, Lord Shipley, in returning to a theme which I am afraid I have sounded more than once in debates over this Bill about the necessity for district authorities to be represented. It is a very important point in relation to the shire county areas. My Amendment 238H, which raises a different and potentially significant issue, calls for the health and well-being boards to have the duty to agree the, "““commissioning plans prepared by a clinical commissioning group””." The health and well-being boards are responsible for drawing up joint strategic needs assessments and the health and well-being strategies. The clinical commissioning groups collectively will be responsible for, I think, some £60 billion-worth of commissioning, which is a hugely important role in the national and the local context. It is important that there should be a mechanism by which that is brought closer to democratic accountability. Given that the health and well-being boards will embrace relevant partners, including clinical commissioning groups, it is right that their plans should be signed off by the health and well-being board. Dr Evan Harris, in an interesting article in yesterday's Guardian, raised among other issues the lack of democratic accountability in this Bill. He has a point, which is particularly relevant in connection with the clinical commissioning groups, which are self-selected. As far as their decisions are concerned, they are not accountable as such. As the Bill stands, they would take the decision on the commissioning plan. They would have to have regard to the views of the health and well-being board but that would be the limit of it. That raises a fundamental principle, to which I hope the Minister will be capable of responding positively. If not, I have to give notice that I would seek to test the opinion of the House. It is an important point to which I hope that he will respond favourably. I certainly hope that he will respond favourably to the amendments moved by others of your Lordships.