In the first place, they could decide not to devolve at all. Part of the process will involve those in the combined authority and in those authorities next to each other deciding how to deliver the services. There is a choice. This is all voluntary, and if people want to do it they will work out a way. It is not very different from what has driven the authorities in Greater Manchester together in the first place. These are places that work across boundaries, and agreement will have to be reached on the delivery of the services. Constituents in one area could say, “Hold on a minute! Are we going to lose out over this?” They will make their decisions collectively on what they will pool and what they want. That is no different from what will happen in the areas that will be split. If people cannot agree, there will not be an order that could possibly be signed off. This will work only when there is a conviction that people have made the appropriate decisions. That is a matter for local agreement, and that is where all of us, as local politicians, get involved. So unless people are convinced that the processes are right, there will be no point in signing anything off.
6.15 pm
I want to complete my remarks on clause 19 stand part and to put the amendments in context. The clause, as amended by the Government amendments, will contain valuable safeguards that will apply to the local devolution of health functions. These make it clear beyond doubt that whatever devolutions might have been agreed with a particular area, the Secretary of State will remain bound by the key duties placed on him in respect of the health service. I shall outline those key duties to the House. The Secretary of State has duties to exercise his functions with a view to securing continuous improvement in the quality of services, to have regard to the need to reduce health inequalities, to promote autonomy in relation to those exercising NHS functions and to have regard to the NHS constitution.
The clause also requires that provision must be made for the standards and duties to be placed on the combined authority or local authority to which the functions are transferred. In deciding what provision, in terms of standards and duties, is to be imposed on the authority in question, Ministers must have regard to important NHS standards, such as those set out in the NHS constitution. The Government’s position is that the health service in areas in which a devolution deal is given effect must remain part of the NHS. That principle was firmly emphasised in a memorandum of understanding between NHS England and Greater Manchester that was signed earlier this year.
Clause 19 also provides that regulations under section 17 of this Act or an order under section 105A of the Local Democracy, Economic Development and Construction Act 2009 must not transfer any of the Secretary of State’s core duties in relation to the health service as set out in the National Health Service Act or in relation to the NHS constitution. The Secretary of State’s duties include a duty to promote a comprehensive health
service and a duty to exercise his functions with a view to securing continuous improvement in the quality of services, as I have just set out.
Clause 19 also sets out that regulatory functions vested in national bodies in respect of health services will not be available for transfer to a combined or local authority. As I have already said, that covers the Care Quality Commission and Monitor, among others. We want to be clear that local devolution settlements will not devolve the regulatory functions of Monitor or the CQC, for example, or change the way in which our national regulators operate to protect the interests and safety of patients.
Finally, clause 19 sets out that where any transfer or conferral of health functions is made to a combined or local authority, the Secretary of State must make provision about the standards and duties to be placed on that body, while having regard to the relevant national standards, information and accountability obligations. The elements to which the Secretary of State must have regard include the standing rules for NHS England and clinical commissioning groups, the recommendations on quality standards published by the National Institute for Health and Care Excellence, and the NHS constitution.
Devolution deals for health are designed to give local areas greater autonomy over how they can work together to improve health and care provision for their local populations. However, the safeguards set out in clause 19 will support the Secretary of State in ensuring, in a transfer order, that when a combined authority or local authority exercises health functions by virtue of the Bill’s provisions, that authority can be held to account over the exercise of its health service functions just as NHS commissioners are held to account now.
Clause 19 and the amendments I have described provide further clarity about the role of the Secretary of State for Health, and what will and will not be included in any future transfer order giving local organisations devolved responsibility for health services. This clear statement in legislation, making provision for the protection of the integrity of our national health service, is intended to provide further confidence for future devolution deals. I ask hon. Members to support the Government amendments and clause 19 standing part of the Bill.