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Local Government and Public Involvement in Health Bill

My Lords, I wish I could give the noble Lord some comfort, especially because of the reasonable way in which he introduced the amendments. I cannot do that, or accept the amendments. I will run over some of the reasons why we think that the amendments raise interesting but problematic questions, particularly Amendment No. 17. It relates to the consultation that must be carried out by local authorities on their proposals, with the opportunity to make representations to the Secretary of State on an alternative proposal by the Boundary Committee. Amendment No. 17 would have the effect of allowing the council, when responding to an invitation, to make a proposal reflecting the results of the consultation with its electorate. I understand the motives behind that. Regarding the consultation process as whole, perhaps I may briefly comment on the process of involving local people. The whole approach to the restructuring process was to enable local authorities, as democratically elected bodies, to decide whether to seek unitary status. One of the key tests that we set out clearly was that the proposals brought forward in the invitation must have support from a range of key partners, stakeholders, service users and citizens. It was a deliberate form of words, because we wanted there to be a formative consultation process, particularly to ensure that local partners and key agencies could respond and contribute to proposals, because they were the people most affected by them. It was also to ensure that local authorities sought the views of local people in the way that they thought best. Among the key consultees have been primary care trusts, strategic health authorities, police authorities, learning and skills councils, universities and a host of others that I could not begin to list. Within that notion of broad support is the principle that local authorities must show that they have involved local people in whatever way is seen as most effective. Councils have adopted a variety of ways of doing that—public opinion polls, local referendums in come cases, citizens’ juries, citizens’ panels and surveys. I am not saying that any method was better than the others. The noble Lord quoted Cornwall, but in Cheshire, for example, the county council commissioned BMG to undertake face-to-face interviews, complemented by a series of focus groups across Cheshire. The county carried out a random telephone survey of 1,200 households and the district commissioned an Ipsos MORI survey of residents’ opinions throughout Cheshire. A ballot of Crewe and Nantwich residents was conducted by the Electoral Commission and there was a survey of opinion among members of the Crewe and Nantwich citizens’ panels. I could list all the methods that the nine successful local authorities used. Some of them took place before the proposals were initially submitted and provided key evidence about how they stacked up. We have certainly met the principle of consultation. I was struck when the noble Lord quoted the case of Cornwall. The district councils commissioned that survey, and districts have often commissioned surveys that have come to different conclusions. We have seen that throughout this process. From the outset we have made it clear what we would be looking for in proposals from democratically elected councils—and that was accepted by them. In particular, we wanted to be able to see a range and depth of support that would show that the criteria for viability could be met—that the proposals would enhance leadership and that they would lead to greater local engagement and better services. There was support for that view and, therefore, viability. It was also clear that, while we expected local councils to seek the opinion of local people, it could not be the decisive factor. It was not the decisive factor in 1992. We made it clear that no group of people or stakeholders would have a veto over the proposal. From the beginning we were clear that the proposal could not be determined by a separate popular mandate. The local representative council making the decision has always been uppermost in our mind. It has been interesting to look in detail at the results of all local polls and inquiries in all the affected areas and to see the variety of opinion expressed and the many different ways that have been employed to seek it. The Secretary of State rightly made it clear that results should be treated with a degree of caution in relation to the balance of opinion, not least because, depending on who asks the question, the districts and counties have come up with different responses to their surveys—as the noble Lord exemplified. It interesting that in Shropshire a review by Professors Rallings and Thrasher, who studied the outcomes, concluded that the process was not flawed but contained inevitable problems. Therefore, we took a series of decisions that were both principled and sensible. We had to make it clear that there was a broad range of support. For the reasons I have explained, I hope that the noble Lord will accept that we have thought hard about this issue, but we cannot go along with the amendment.