Baroness Scott of Bybrook (Con)

My Lords, turning first to Clause 53, I am grateful to the noble Lord, Lord Hunt of Kings Heath, for his probing stand part notice. As we have said more than once, the devolution of health is a complex matter that raises many important questions—particularly, as we have heard, around the relationship between local authorities and the NHS. I listened to the passion of the noble Lord, Lord Hunt of Kings Heath, on this issue. I assure him that I felt as passionate as him 15 years ago; I hope that, at the end of all this, he is not as disappointed as I was. When I was going through this in Wiltshire, the interesting thing was that the staff on the front line—those in the NHS and in local authorities—really understood this issue. They understood the importance of devolution and how they could deliver much more efficient, better services for the people whom they wanted to serve. That pushed me to do this more and more. However, as I have noted previously, many of the determinants of public health sit outside the health system. We must be clear on who is responsible for what. As we have said many times, where additional duties and responsibilities are placed on local authorities, they must be matched with sufficient resources to deliver them properly. In addition, the Government’s approach must be evidence-based and must demonstrate value for money for taxpayers. On previous groups, the Minister mentioned the mayor’s involvement in integrated care boards, and we all welcome that. But it has to go further than that. In my opinion, being a member of an integrated care board will not deliver what we need to be delivered on the ground with health and local authorities. This brings me to Amendment 185 in the name of my noble friend Lord Gascoigne. I thank him for making the case so compellingly. This amendment would prevent the duplication of powers between local authorities and central government. In the realm of health, for instance, we cannot risk the lines of accountability being blurred, whereby functions and responsibilities are devolved down to local authorities, yet Whitehall does not equip them to deliver effectively or continues to do the same jobs itself, leading to duplication. This is precisely the difference between the Government’s current approach to devolution and what genuine community empowerment ought to look like. This amendment aims to correct that by ensuring that, when a function is devolved, it is also relinquished by central government, while still permitting the appropriate oversight where needed. If the Government truly believe in local community empowerment, there can be no greater vote of confidence than supporting the principles set out here, trusting local authorities to do the jobs devolved to them fully, and giving local people clear, transparent lines of accountability. This is a matter not of meaningful devolution but of efficiencies and effective government. I look forward to hearing the Minister’s response on both these important amendments.