Local Government and Public Involvement in Health Bill

Whilst acknowledging aspects of the Bill seeking to remove targets and red tape, Anne Main fears too much power will still reside with the Secretary of State and unelected regional assemblies who rarely seem to listen to the views of local people.

7.53 pm

Anne Main (St. Albans) (Con): It is a delight to follow the hon. Member for Stoke-on-Trent, North (Joan Walley). I want to look at the local government reorganisation that is proposed in the Bill. Like many other Members, I welcome some of the measures that apparently seek to give greater freedoms to local communities and to remove what we all hate most in local government, namely, targets and red tape. They cause sclerosis at local government level, as I and many other Members who have served in local government know, and they leave communities feeling that local government is just a mouthpiece for central Government diktats. I raised this issue earlier, and I know that other hon. Members share my frustration. Consultation often pays lip service to local views, with the outcome already having been determined by some central Government bean counter. It seems to me that the Government ask a question, and if they do not like the answer, they keep asking it until they get the right one.

The other main driver that worries many in local government is the fact that they have little control over the purse strings. The thumbscrew approach to local government finance causes deep unhappiness, involving too many levers which mean that local authorities cannot deliver what local people want. I raised this issue during our deliberations on the Sustainable Communities Bill. If people have no control over the finances of their local council and over what their council can do, they have no real power at all.

Too often, the Government appear to pay lip service to localism while allowing more and more important issues, such as planning, to be decided at regional level. Many Members on both sides of the House have great difficulty in accepting the regional approach. That approach causes intense annoyance in constituencies such as St. Albans, and is a prime example of the Government not listening. For example, I happened to have the delight of attending the east of England draft planning review recently. Such events are familiar to many in the Chamber who take a keen interest in local government. They tend to go like this: Hertfordshire proposes a draft housing figure of 66,000, which we believe we can deliver, but we are told to go away and come up with a figure that is more in line with central Government thinking. The council then reluctantly proposes 72,000 homes with no green belt encroachments. However, we are told that we should come up with an even better figure, and advised that 79,000 might be nearer the mark, although it would involve some green belt encroachments. Then, because our answer is obviously still not quite right, we are informed in the review that we are likely to have 83,200 homes.

I struggled when I heard the Minister say earlier that local people should shape the places where they lived and have a greater say in the places where they lived and the services that they received. That is not happening now, but if I honestly believed that the Bill would deliver that, it would have my support. However, I do not believe that it will. There is strong opposition to the ratcheting up of housing totals, and fury at the whole rigmarole of councils being asked what they would like to deliver, only for the plans to be revised centrally. Unanimous local opposition to them seems to have no effect and falls on deaf ears. The Government do not allow local people to make those decisions, and the Bill will certainly not change that.

I wonder whether there will be a shift towards a unitary approach, with the scrapping of the existing tiers of local government. The proposals ring alarm bells for me. Indeed, I would be grateful if the Minister could tell me whether we are going to have district elections in 2007. This is a contentious issue, and perhaps it involves a thought in process in the Minister's mind. Perhaps if she gives it greater thought this evening, we shall be all the wiser.

I am extremely concerned that the Government acknowledge in their own review that, despite the Local Government Acts of 1999, 2000 and 2003,

"Public satisfaction with the overall performance of local Government is low compared to most other public service providers and has declined since 1997...current local Government modernisation agenda policies appear to have done little to increase public satisfaction with local Government".

So we are going to get a bit more restructuring, because it has obviously proved so wonderful-according to the Government's own assessment of the situation-that we need more of it. However, the proposals in the Bill, although quite radical, will achieve little more than moving the deckchairs around on the Titanic. If we have problems in local government, altering the structure without altering the emphasis on delivering localism will not achieve much at all.

Consequently, I have little faith in clauses 1 to 30, which propose to give the Secretary of State the power to implement structural changes to local government in England so that areas with a two-tier arrangement can easily be reorganised into a single unitary tier, but also scrapped altogether if the arrangement does not meet with the Secretary of State's approval. This will be a win-win situation for the Secretary of State, and a lose-lose situation for local authorities and local people. If people feel divorced from decision making, subjected to imposed housing quotas, stifled or driven by targets and deprived of funding, and if they get even less funding if they do not comply, how can they think that things are decided locally, and why would they have any more confidence in a Government who give more power to the Secretary of State to decide that, if they do not like the system, they can scrap it altogether?

The local government restructuring will be a costly exercise. As my hon. Friend the Member for Meriden (Mrs. Spelman) pointed out, research by Professor Mike Chisholm of Cambridge university suggests a transitional cost of £121 per person. Given that my council tax payers do not like paying for local government, and prefer to pay for services, not bean counters, the prospect of having to pay £121-perhaps more, as I have never known a Government figure that does not rise-will fill them with dismay. It will hit those on fixed incomes and pensioners the hardest. What are they getting for that £121? They will not get a better service; they will get a more divorced service, and people whom they do not recognise, do not know and cannot talk to, unlike their local councillors. Having been a local councillor, I know that people can ring up local councillors and talk to them; they are accountable and known. The higher up the decision making is, the less accountability there is, and the less empowered people feel when they are fed up with what their local councils do.

If the Government are hoping for savings, they should heed Professor Chisholm's warning:

"it is unrealistic to suppose that the creation of a single unitary council in an otherwise two tier county area will generate financial savings and that there is every prospect that ongoing costs would in fact be increased."

That is not just transitional costs; it is ongoing costs. As someone who has a two-tier authority, I do not welcome even more costs. As the Secretary of State for Communities and Local Government admitted in 2006, the Government reorganisation is generally "a great distraction". My hon. Friend the Member for Meriden touched on that point. Many Members will be wondering what we are being distracted from. Partly, perhaps, the intention is to further the Government's creeping programme of regionalisation-regions by the back door. I hate to keep referring to the draft east of England plan review, but Mr. Tim Frehey, head of development of infrastructure for the east of England, explained that we would have regional targets on carbon dioxide emissions, and that we would have great control over housing totals. However, the beleaguered St. Alban's and Decorum officer who attended the meeting, Mr. John Chapman, said that we would have "no choice" over housing totals. My local council wants to ensure that local people are listened to. The thread for the regions is becoming stronger and stronger, and local democracy is diminished as a result.

The housing totals debacle is a barometer of this Government's approach to regionalism: if one alters the structure, one eventually gets the right answer. The district and the county said no, so the exercise had to be done again. Perhaps I will be called a cynic, but it seems that if the district and county say no, scrapping the district and county is the way to get the right answer: a resounding yes for the Government's housing totals.

Martin Salter (Reading, West) (Lab): Like the Greater London council.

Anne Main: I note the hon. Gentleman's comment from a sedentary position: not having been a member of the GLC, I would not know.

Given the Government's propensity to trample over local opinion, clause 8(2)(a) contains a worrying phrase:

"the Boundary Committee may recommend to the Secretary of State such boundary change as, in consequence of the review, seems to them desirable having regard to the need to secure effective and convenient local government".

That prompts the question of what is local. As we have regional targets left, right and centre, I would dispute that "local" means my district. It also prompts the question of what is effective and convenient and for whom; I would suggest that it is not for my constituents, but possibly, for regional or even national government. I do not believe that the needs of my constituents are at the heart of the Bill. This Bill has far-reaching implications and I look forward to debate it in Committee.

Briefly, as I am conscious that other Members wish to contribute to the debate, I shall address the apparent democratic deficit for health in the Bill. That issue has been raised by many Members, and concerns were expressed about inspections with LINKs, to which the Minister responded that people were entitled to do reviews. If reviews and inspections are similar, I do not know why we need a change of words. If they are not similar, it is a definite change of emphasis, which I do not welcome.

My local council has already lost its scrutiny of health. It is not happy about that, and nor are local people. They will not welcome a further dilution of their input in that regard. People on the street and the council are infuriated by frozen posts, massive cuts in services and, especially in my constituency, the loss of the proposed super-hospital. The Government are strong on consultation, which is an issue that I raised in relation to the Sustainable Communities Bill, but I am not sure that they are long on listening. A long consultation was undertaken on option 1 and option 2. Everyone was voting like mad, and it was covered in the local newspaper. Ultimately, however, we were told that there was no such option. It had all been a waste of energy and expectation for the local community. Local government, with its hold on the purse strings, just decided that the hospital was not going to happen. That further dilution of patient involvement, along with the lack of accountability, fills me and other hon. Members with great concern.

The proposed new LINKs need great scrutiny. The British Medical Association has some valid concerns. It observes that LINKs may not work well with those who are

"less educated or less able to dedicate time",

It is important that people feel that they can contribute, and are not intimidated by a vast system that does not to listen to the patient's voice. The BMA also says:

"There is a danger that LINks may be patronised and manipulated by managers",

and,

"Lack of Co-ordination for LINks does not formally enable sharing of information and ideas."

Again, a larger and more unwieldly structure-the Minister tells us that hundreds of people, and almost anyone who wants to join, can be involved-will result in a worrying dilution and lack of expertise.

The hon. Member for Leicester, South (Sir Peter Soulsby), who is not in his place at present, raised valid concerns about the health aspects of the Bill. My hon. Friend the Member for Billericay (Mr. Baron) also referred to patients being marginalised. I will nor revisit those concerns. I hope, however, that the Government will start listening to concerns of hon. Members who feel that the Government are moving not towards localism but to a convoluted and complicated form of bureaucracy, which will mean that the person in the street will not understand what is going on, and will feel yet again that things are being done to them, rather than for them and with them.

Were the Bill genuinely empowering local councils, and giving greater scrutiny on health, I would support it. [Interruption.] I hear the Minister muttering away, but I will not explore the jelly fish idea, which grasped our attention for a while. I share the concerns expressed that we will end up with an organism that will not deliver what people want.

8.8 pm

...

ANNE'S EARLIER INTERVENTIONS IN THE DEBATES

Anne Main (St. Albans) (Con): May I refer the Secretary of State back to her earlier remarks, in which she said that local government had expressly wished for a short window of opportunity, namely the period ending on 25 January? Will she tell us on what evidence she based that statement?

Ruth Kelly: Of course, there has been conversation on the subject between central and local government for a number of years, and it began before the Government came to power in 1997. One point that was made to me very forcefully was that local governments did not want unitisation and unitary authorities to be the only thing that they were thinking about for months and years to come. They wanted to get on with the job of delivering for local people, but in certain cases they made a powerful argument for change. They said, "Well, if you're serious about the place-shaping role, and if you really want us to deliver value for money, and you want us to keep the council tax down to its lowest level, give us the opportunity to present our case." The agreement that we reached was that the strongest bids would be considered against extremely strict criteria, but that the window of opportunity would then close, and the unitary debate would, I hope, close down thereafter.

...

Anne Main: I am a little confused. The Secretary of State made a comparison with a directly elected mayor. However, he is directly elected by the people, whereas a council leader will be elected by elected members, who may not have a large mandate to serve on the local authority. Why did the Secretary of State make a direct comparison between a directly elected mayor and an elected council leader? It does not stand up.

Ruth Kelly: I described a directly elected mayoral system and an indirectly elected leader system. They are not equivalent, because one is directly elected and the other is indirectly elected, but they both have strong mandates and are visible and accountable to local people. When devolving more power to local people, it is important to have a visible and accountable local leader. One is directly elected and the other is indirectly elected.

...

Anne Main: Does the hon. Gentleman agree that people do not choose to serve more than one term because they are accused of not delivering to the public, even though they have very few powers and often just have to deliver what the Government ask them to? They get all that public hatred, and have no power to do anything about it.

Sir Peter Soulsby: Many local councillors share that perception, but the problem also stems in part from the denigration and undermining of local government that took place under the previous Conservative Government. That has contributed to the present low morale among members of local government."