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Local Government and Public Involvement in Health Bill

My Lords, this is a refreshing return to some of the fundamental principles in the Bill. I could not agree more with the noble Lord in that I do not for a moment believe that Whitehall knows best. The thrust, burden and tone of the Bill and of the debate at each stage of our proceedings has been to reinforce and verify the fact that Whitehall does not know best but is in a more balanced partnership with local government which can reflect the real needs of the local community. That is reflected, in some ways, in local area agreements against the background of the country as a whole and its needs. The noble Lord was quite right that the Bill is about empowering local communities and local councillors. Various provisions celebrate the role of local councillors and strengthen their visibility. I shall talk about the community call for action in a moment. The Government started this process with the White Paper; and the Roberts commission will now take us there in terms of the quality and scope of the people we want to see in local government and the tasks they have to undertake. Two arguments flow from that: the noble Lord deployed the wider argument in relation to the new unitaries but also about the making of place. So much has been said about place-making in recent months, led by Michael Lyons, who introduced the term. I believe it is powerful and effective to talk about making places; the partnerships which are reflected in the Bill and the local area agreements are about people coming together to say what they want about the place they live in and agreeing on how they deliver that through local government, now working in much more explicit and determined partnerships. Beyond place-making in the local area, the noble Lord talked about other things that we have addressed in the Bill. How do we work beyond a local area so that the sub-region and all its natural contours can also be reflected in the devolution of power in the making of, for example, multi-area agreements, which will grow from the local area agreements? My honourable friend in another place talked about the disposition of power to make something of the sub-region—transport, of course, has a particular relevance, but there are other factors outside local areas as well. I agree with the noble Lord; he is right to raise those points. He is also right to remind me of the power of the term ““flexibility”” and its incidence in our discussions. There is nothing more flexible than the local area agreement. It represents degrees of flexibility between partners and between local partners and local government through regional offices in the design of the future. He referred to dynamism and the responsiveness to local need and local vision. That is absolutely right. Considering the partnerships, the nature of places, the diversity and strengths as well as the real needs and challenges gives us an understanding of what the local area agreement is really about. That takes me to the question in the amendment about the nature of the debate on local area agreements. Who makes the local area agreement and on what terms? This will come up in the next amendment. The essential point about the local area agreement, as we have discussed at every stage, is that it is locally driven. Its most distinctive feature is a negotiation between local partnerships and central government. It will be the only place that central government and local government will meet in the future to discuss the relationship between the overarching needs of the country as a whole, the economic, social and environmental pressures that we face, and the local area. The idea that there is a built-in conflict or opposition between national and local objectives is contrary to common sense and to practice. That practice has already been tested in the 17 local partnerships which are developing. Whether the needs of the nation include better healthcare or greater success in schools, they will be settled at the local level to reflect the real challenges that that local community faces. I believe that the Bill strikes the right balance between local authorities and partners. We cannot take central government out of the picture; it is where local government and national government now meet to discuss national priorities and how they will be reflected in local action. We have stripped down the number of indicators from 1,200 to 200 and the performance regime has been lightened. Essentially, an agreement should be genuinely driven by what local people want and say they need, working in partnership to deliver it. Sheffield wants to tackle health inequalities by setting a target to increase life expectancy. It is doing well against the national average; therefore, it may not be necessary to designate this and make it a national target. But Sheffield wants to continue improving health equalities, so it could decide in the course of negotiations to include a more stretching or demanding local target. National government concerned about obesity or care of the elderly—whatever the 200 top indicators will be—will ask local authorities what really matters in the area and what they need to monitor and designate in terms of national ambitions. They will ask the local area to tell them what it thinks is most important so that they can work it out together. That has been happening all over the country over the past three to six months, as people have begun to work through these processes. It is innovative and challenging, but as a result we will get something that the local community can believe in and deliver, recognising that these things matter to all of us nationally. Amendment No. 39 would allow a draft local area agreement to be initiated either at the direction of the Secretary of State or at the direction of the Secretary of State if requested by the responsible authority. Clause 106, on the other hand, allows only for a local area agreement to be initiated by the Secretary of State. That is more a technical provision than anything else. It is obviously critical that there is a clear and agreed process and timetable by which LAAs will be negotiated and signed off, and introducing two possible routes for initiating an LAA—one at the discretion of the local authority— would cause genuine confusion in the process. Clause 106 sets out that this process will formally be at the direction of the Secretary of State but we will elaborate on this in guidance. That guidance, significantly, is being developed collaboratively—for example, with the Local Government Association—and will set out the process and the timetable. That is significant because the partnership with LGA runs through the Bill and the noble Lord, who has spoken passionately about Cornwall, knows that local authorities are keen to do this. They see the local area agreement—and, in time, they will come to see the multi-area agreement—as offering huge possibilities of new ways of working and a much better chance of success, whether that is in reducing the rates of teenage pregnancy or in reducing the stubborn pockets of worklessness that we still have in some affluent areas. With that in mind, I hope the noble Lord is confident that the debate has addressed the issues that he raised and that he will feel able to withdraw his amendment.