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Health secretary can overrule devolved health and social care decisions

Decisions made by Greater Manchester under their devolved health and social care powers could be overturned by the health secretary if he disagrees with them, according to a government minister.

During a Lords committee discussion on the Cities and Local Government Devolution Bill, local government minister Baroness Williams was asked about the effect it would have on the NHS.

Lord Warner asked if the health secretary would have the power to overrule a devolved decision made by the partnership of local authorities, CCGs and NHS England regarding care in Greater Manchester.

The former Labour health ministers used an example of a potential decision to cut the amount of acute beds available in hospitals.

“The CCGs in Manchester could all agree that they should take a large number of beds out of acute hospitals in Manchester – not anywhere else – because it was in the best interests of and would achieve better health outcomes for that population,” he said. “Could they – all the interested parties, CCGs and even NHS England, with the combined authority – agree that that is sensible to do?

“Could we then have a situation in which the secretary of state, under pressure from some bits of the local community or from the acute hospital, declined to approve that well thought-out plan by the combined authority with the CCGs?

“It is a straightforward question. Is the answer yes or no to whether the health secretary can overrule them?”

In her response, Baroness Williams said that what was being devolved was a “partnership arrangement” to develop health strategies and commission services, and that within that partnership if the health secretary thought everyone was making a collectively wrong decision “he would have something to say about it”.

Lord Warner continued to press, saying that it would not be a partnership if the health secretary reserved the power to overrule a local decision because he thinks it’s the right thing to do.

Baroness Williams clarified: “My Lords, I was not saying that the Secretary of State would overrule them for overruling’s sake, but if it was fundamentally a wrong decision, I am sure that he would have the power to intervene. I think that that is what the case would be.”

She added that the government “cannot have a situation where there is unfettered ability for people to do things without any checks and balances”.

Her definition of a “bad decision” was one that had “negative” consequences for patients and service users.

“The secretary of state would have to intervene or call into question the decision of the collective bodies that had made it in partnership,” she said.

However Lord Woolmer of Leeds, another Labour peer, said devolution means giving power to the local level, and that it is not devolution if they can only use that power on decisions that central government agrees with.

“It is not a question of whether they have made a mistake or done something wrong, but of local choice,” he said. “The minister talked about a bad decision. To say that a local decision is a bad decision because it differs from a view that the secretary of state takes does not seem to me to be in the spirit of devolution.”

The debate on the issue is set to continue today. Lord Warner is due to propose that “any NHS responsibilities” can be transferred to combined authorities when the health secretary believes this is in the “best interests” of residents, and that the deal lasts for “a minimum of five years”.

The peer also indicated he plans to revisit the issue of the health secretary having the power to overrule local decisions, which he described as “an Exocet under some of the principles in the Bill”.

(Picture by: Joe Giddens / PA Wire)

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