Local Government and Public Involvement in Health Bill
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Local Government and Public Involvement in Health Bill
Status
The Public Bill was introduced to the House of Commons by Ruth Kelly, Secretary of the Department for Communities and Local Government, on December 12th 2006. The Bill has completed its Second Reading in the House of Lords and has been through examination in committee.
Summary
The bill is concerned with altering the structure of local government in England and Wales. In particular, it aims to introduce strong new leadership models which offer voters greater accountability for the actions of local government. It is a lengthy document which aims, amongst other things:
- To introduce stronger powers for overview of councils, including the power for all councillors to refer matters to the relevant scrutiny committee of a council.
- To introduce a “community calls for action” mechanism, whereby citizens will be able to refer matters to any councillor and ask them to take such a matter up with relevant committee of a council.
- To remove the requirement for the Secretary of State to give consent for new byelaws to be passed and for the creation of parish councils.
- To allow the creation of Parish Councils in London. These councils can be styled under some other name, if local residents find the term “parish” to be objectionable.
- To devolve power to local authorities enabling them to carry out community governance reviews in order to establish, amalgamate, alter or abolish parish councils. It further sets out measures to permit parish councils to style themselves as community, neighbourhood or village councils.
- To encourage a move from two-tier to single-tier local government.
- To allow local authorities to alter the structure of their executive, e.g. by instituting a mayoral system.
- To abolish the Commission for Patient and Public Involvement in Health and the Patients’ Forums and to require local authorities to commission support and oversight arrangements for Local Involvement Networks (LINks). The bill also introduces a duty to consult on the provision of service and on decisions which may affect the operational running of services.
It is notable that the powers which the bill grants to local government are quite limited:
- The bill does not grant any significant new financial powers to local government. De facto control thus largely remains in the hands of Westminster.
- While granting some additional powers to local government, the bill does not give any constitutional protection or foundation to those powers. The basic constitutional arrangement whereby nearly all power is vested in the House of Commons is left unaltered.
House of Commons Debates
1st Reading
The bill was introduced to the House.
2nd Reading
The Secretary of State for Communities and Local Government Ruth Kelly argued that the bill would strengthen local government, once enacted.
Mr. John Redwood (Wokingham) (Con) argued that the government was attempting to ignore the fact that the voters of the North East rejected the opportunity to be granted a regional assembly, in a referendum:
“What part of the “No” in the north-east did she not understand?”
He also accused the government of making needless, confusing, changes to how the
Mrs. Caroline Spelman (Meriden) (Con) argued that the Bill is inadequate and that it would be better to enact the Sustainable Communities Bill instead:
“We will end up with a heavily compromised agreement between representatives who are in hock to their masters in Whitehall. That is why we have proposed something more radical in the Sustainable Communities Bill, which gives local councils far more discretion over the way in which money is spent locally and, for the first time, total transparency in regard to how much is spent.”
Andrew Stunell (Hazel Grove) (LD):
“There is no commitment from the Government in the Bill to rebuilding a strong democratic society, and no vision for the future of grass-roots democracy. We will vote against the Bill today and seek to improve it in Committee. The Government have lost the respect of those of us who believe that local democracy should be the core of our national democracy. There is no commitment from the Government in the Bill to rebuilding a strong democratic society, and no vision for the future of grass-roots democracy. We will vote against the Bill today and seek to improve it in Committee. The Government have lost the respect of those of us who believe that local democracy should be the core of our national democracy.”
Mr. David Curry (Skipton and Ripon) (Con) argued that the powers granted to local authorities by the bill are inadequate:
“The enactment of byelaws without the approval of the Minister of State is welcome, but will it be possible to enact byelaws dealing with the issues that my constituents get excited about? They are constantly demanding traffic-calming measures, for instance, and measures to deal with antisocial behaviour—which, no doubt, will be covered by the local area agreements in any case.”
Joan Walley (Stoke-on-Trent, North) (Lab) pointed out the oddity of putting forward the bill before Sir Michael Lyons’ white paper on local government was published:
“It is strange that, having waited so long for the White Paper, we are holding the debate without having had the benefit of the Lyons review and a clear idea of future local government finance. It is important to link local government funding with the way in which people who are elected to be strategic leaders respond to what local communities and people want. Local government must be fit for purpose.”
House of Commons Committee Hearings
Amongst the groups to give oral evidence to the committee were representatives of Unlock Democracy.
Central to Unlock Democracy’s evidence is the argument that the Sustainable Communities Bill would go further than the Local Government and Public Involvement in Health Bill and overcome many of the latter’s limitations.
The following comments were made by the representatives of Unlock Democracy:
Peter Facey:
“The Bill devolves power by giving powers to parish councils, and in relation to byelaws, and that is to be welcomed. However, with respect to the powers of Westminster, and in most policy areas, it reorganises the powers of local government and gives local government the ability to administer things better, but it does not actually shift power significantly downwards to local authorities or communities.”
Peter Facey:
“The community call for action is very good, but we would like to see an opportunity for other tools. The Government have introduced things such as the ability to petition for mayors and now for executives—the first time that power has existed. That is great, but we would like to see that kind of idea extended more broadly, so that communities can use those tools and, even where their councillor does not agree with them, make a significant view be heard. There need to thresholds and safeguards, but there should be safety valves in the system to allow a community to exercise power outside of an election.”
Alexandra Runswick:
“One thing you have to do with any level of devolution is give the institution some power to effect change. The Bill goes some way to doing that, but parish councils have been used very differently in different areas. There are certainly models of really excellent parish councils that involve communities and actually provide a vision for what that community wants to achieve, to change and to develop. However, they can also be quite small-C conservative and be used as a tool to block change. Therefore, it is very much about giving parish councils the level of support that they need, making sure that it is possible for new people to come into the process, and not being too prescriptive about exactly what form a parish council has to take.”
Peter Facey:
“We are not arguing that everything needs to be put down to the local level; we are saying that the current balance is wrong. The Government agree that certain things are being directed from central Government or central Government agencies that can be better decided locally, because the local council and the local community have more expertise in relation to their own problems, and are therefore better able to work out what the priorities should be. We are not saying that everything has to be shifted downwards, but that the balance is wrong and we would like to see a better definition of it.”
3rd Reading
The bill is passed and sent to the House of Lords
House of Lords Debates
1st Reading
The bill was introduced to the House.
2nd Reading
Baroness Morgan of Drefelin introduced the bill and argued that a central aim of the government, in introducing the bill, was to give a stronger voice to local government and to increase local control of the NHS, with the particular aim to give more say to patients.
Baroness Hamwee criticized the bill for not giving meaningful, financial autonomy to local democratic institutions:
“I have to say bluntly that I regard this as a bad Bill. It purports to be decentralising, but it does not address the most centralising feature of local governance, which is finance. Public accountability for funding decisions is blurred because so large a proportion of funding comes from central government.”
Lord Low of Dalston criticized the bill for failing to clearly explain the composition and role of the LINks:
“As for what is missing and still needs to be filled in, the Health Select Committee in another place described the proposed changes as “vague and woolly”. So they are. The Bill is silent on the membership, structure and accountability of LINks or the infrastructure to underpin them. Indeed, the Minister sought to make a virtue of the lack of infrastructure, but I venture to think that your Lordships will find that less than convincing.”
Viscount Eccles argued the role of local government needed to be clarified, given the increasing importance of regional bodies such as well as the growing importance of the European Union:
“As yet, local government is still caught up in the continuing tension between systems of central control and the alternative of decentralised local independence with undiminished accountability. Local government also remains threatened by regionalisation. The Bill is silent on the subject, yet parallels with the re-emergence of the European constitution must be in many people’s minds. What do the Government believe? Are today’s issues better dealt with nationally or locally, but not in between, or only nationally?”
House of Lords Committee
The bill was subjected to review by committee from 5th until 25th of July 2007.
Other Organisations' Views of the Bill
Local Government Association
The Local Government Association takes the view that the bill makes “some very useful steps towards decentralisation and deregulation”. The Local Government Association’s analysis of the bill However, the organisation expresses concern that the bill allows the Secretary of State to impose restructuring upon two-tier councils.
The organisation is also concerned that the bill falls short of the recommendations of the government’s White Paper on Local Government by omitting:
- An explicit upper limit on the number of national targets
- NHS and Foundation trusts having regard to LAA targets
- A single system for a 'community call for action' on all local issues
The Bill fails to deliver councils significant powers over planning, housing, transport, skills and economic development. Such powers remain largely the preserve of national and regional government. The proposed legislation also fails to cover the funding of local government, which remains ultimately under the control of Westminster.
The LGA intends to seek the removal of the power to impose unitary status; to seek assurance from the government that all the positive steps outlined in the White Paper become legislation; to press for joint waste authorities to be enabled during this process; and to call for devolution over economic powers in forthcoming legislation and next years spending review and a return of the business rate.
Centre for Public Scrutiny
The CfPS is currently scrutinising the success of the “early adopter” trial scheme for LINks which is being run in the following areas: County Durham, Doncaster, Dorset, Hertfordshire, Kensington & Chelsea, Manchester and Medway. The Centre for Public Scrutiny’s analysis of the bill
British Medical Association
The British Medical Association’s central concern with the bill is that it will put control of the heath services in hands of those who lack the requisite technical expertise to make effective and useful decisions about how the health services should be run. With regard to the broad issue of public and patient oversight of and involvement in the health services, the BMA takes the view that such bodies can help to educate the public and patient body, to allow the public to understand the achievements of the health services and to allow the public the understand the constraints and limitations which the NHS operates under.
The BMA takes the view that the bill has several strengths. It may clarify and simplify public involvement by replacing numerous PPI forums with LINks. Where those involved in the LINKs are “well educated” The British Medical Association’s analysis of the bill and can dedicate sufficient time to them, the bodies may work well. LINks will have the power to inspect provider’s premises.
The BMA also take the view the bill has several weaknesses. LINks may not work well when members are not well educated and are unable to dedicate sufficient time to them. LINks “may be too closely allied to local authorities to be independent of local politics and any conflicts of interest that may arise” and “there is a danger of LINks being patronised, out-thought and manipulated by managers”. The British Medical Association’s analysis of the bill
National Council for Voluntary Organisations
The National Council for Voluntary Organisations takes the overall view that the bill is a move in the right direction, which has the potential to empower voluntary organisations at a local level. They state their intention to ensure that the bill is amended, if required, to ensure that it devolves meaningful levels of power from central government to a local level. The following are some quotations from their briefing on the bill:
“We will be monitoring the guidance and working with Members from both Houses of Parliament to table questions and amendments, with a view to strengthening the duty on local authorities to consult with other stakeholders.”
“If necessary we will work with Members of both Houses of Parliament to table questions and /or amendments to the bill, in order to ensure that the opportunities for local people to bring matters to the attention of local elected representatives are sufficiently robust.”
“We will be working with national local government representative bodies such as the LGA and IDeA to ensure that any guidance for community governance structures takes the value of the local VCS into account.”
“We welcome the provisions set out for local involvement in health and social care. Local Involvement Networks will provide a new opportunity for the local VCS to contribute to this process. Involving voluntary and community organisations is not a proxy for engaging local communities and service users themselves, however they can promote public engagement in the NHS in a number of ways. As well as having direct knowledge of local needs and preferences, and experience of engaging with local people, they also provide a channel of communication to local communities. As such they can enable a diversity of views to be expressed and give voice to a range of different interests and concerns. Most crucially they can provide a link to those who would otherwise find it difficult to participate or make their views heard.” The National Council for Voluntary Organisations analysis of the bill
