Lord Hunt of Kings Heath (Lab)

My Lords, I am very grateful to my noble friend. It has been a really interesting and encouraging debate. I share the view, concern and thrust of the amendment from the noble Lord, Lord Gascoigne, and I thought my noble friend was pretty positive in response. The noble Lord, Lord Wallace, made a very pertinent point about the difference between delegation and devolvement. As the noble Lord, Lord Lansley, pointed out, although we talk about devo Manchester in relation to health, it was actually delegation, with the Secretary of State retaining responsibility. I do not think that in the short term we will be able to move off the Secretary of State’s responsibility. That goes back to 1948. However, I think a lot more could be delegated, and there are issues where we could start to look at real devolvement. The noble Lord, Lord Lansley, reminded me that we have the joys of another NHS reform Bill coming to us in the next few months, and we will have an opportunity to discuss and debate this further. I will be looking particularly to see whether the Bill tries to nibble away at what is already contained in Clause 53. One has to say that, at the time of the agreement over Greater Manchester, it is well known that NHS England was not in the loop in the original decision-making. I am afraid that, because of that, it has not been keen to see progress such as has occurred in Manchester. The noble Lord, Lord Shipley, said that Manchester was essentially a pilot and we should have a proper assessment; I agree with that. My noble friend was very encouraging. I understand this whole question about the Secretary of State’s accountability to Parliament for the running of the National Health Service and how that squares with giving more authority to local authorities to have a role in it. We can find a way through. For instance, this always struck me: if we are going to have pilots, why on earth can we not have one mayoral authority taking on responsibility for an ICB—not having one place on it but actually doing it? Albeit it might be under delegated powers from the Secretary of State, at least let us dip in the water of freeing up the system. Looking at how the NHS is run at the moment, how many restructurings do we need to show that central command control simply does not work? Having said that, I withdraw my opposition to Clause 53.