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Local Government and Public Involvement in Health Bill

My Lords, I feel that I have answered most of these amendments previously and I try not to repeat myself. I appreciate the spirit in which the noble Baroness has moved the amendments and the seriousness with which we have debated over the past three stages the relationship between local and central government, but the amendments would have the effect of destroying that partnership by removing the key partner. We would be left with a situation in which local authorities would be dictating to central government what central government’s priorities were, which would be unbalanced and unrealistic. The most interesting feature of an LAA is the requirement for discussion-based negotiations between local partnerships and central government. We believe the right balance has been struck and that we cannot take the responsibility away from central government; it will be the only way in which central government can signal priorities and involve individual localities. It sits alongside the significant decision to strip down the national indicators from 1,200 to 200, which has been much welcomed by local government. Along with that, the performance regime has been lightened to meet the real risks and challenges and it now has far greater freedom to determine how to meet local needs. The problem with the noble Baroness’s amendments is that they would pre-judge the negotiations that have already begun and will go on over the next six months. We have already made clear in the operational guidance that we published on 18 September that these new style LAAs will have to have robust and open negotiation at their hearts. The effect of the amendments would be to try to distinguish prior to the approval of targets the ones which are of local interest and those which are of national interest. We presume a conflict of interest, which I addressed previously, because I do not see why that should be seen to be the case; it is a false distinction. The effect of the amendments will be that from within the draft LAA local partners will need to specify which targets are of national interest. There is a presumption that the Secretary of State is a tyrannical figure dictating to localities rather than negotiating with them. That is not the case. We are talking here about the role of the regional officers, a collection of delightful and efficient people who are well known in the locality and know the area well. There will be priorities that they will want to tackle and there will be total agreement on the fact that they are both locally and centrally important. As I said, the priorities may be reducing worklessness or may be improving school standards; they will be different in different areas. It will depend on the circumstances of each case whether or not they are designated as national targets. Essentially, those will be the only targets which are reported on because the local targets, the non-designated targets, will not have to be reported on. If we removed the Secretary of State from the process, we would have a purely local agreement. Within that, local authorities would not find themselves totally free of central government’s priorities, health and welfare; what they would find was that central government departments would employ their own individual targets for each authority along with separate performance management, so we would be back to a situation in which there were far more targets and far more—I would not say anarchy—but individual negotiation. We are trying to get away from that sort of situation. In the kindest spirit I suggest that what noble Lords propose is not only unrealistic but actually means that we would have to turn away from those genuine improvements that we have made to reduce the role of local government and which we see now in the LAAs, which introduce a new and better way of doing things and have been welcomed. I hope that the noble Baroness will accept those arguments. She has been valiant in her championing of local targets and local authorities, as I always suspect she will be, but I hope that she can now withdraw her amendment.