Greater London Authority Bill

My Lords, I am pleased that we were able to meet, and I am sorry that the noble Baroness is still not convinced. I hope that by responding to this short debate I might be able to help. I am happy to do as the noble Baroness, Lady Hamwee, suggests and put on the record the comments I made in my letter. However, the most senior public health appointment in London is the regional director of public health. I believe strongly that this is the right person to advise the Mayor on health issues. Because of their professional position, the experience they have had in order to get to that point and the work they do, they personify the best position in terms of public health within London, and they are therefore the best person to advise the Mayor. I feel that quite strongly. Amendment No. 30 seeks to replace the provisions of the Bill relating to the appointment of the regional director as health adviser with the requirement that she should be an employee of the Authority. I strongly resist that, because if they were an employee of the Authority, by definition they would not be the most senior public health professional in London. Someone else would be doing that. Also to be resisted is Amendment No. 32, which seeks to loosen the requirement that the regional director is to be the health adviser. In appointing the regional director of public health as health adviser to the Mayor and the Assembly, the Bill simply seeks to formalise current arrangements which many agree have worked very successfully on an informal basis. It is because they have worked well on an informal basis that we are seeking to formalise them so that they can be perpetuated. Experience tells us that that is the right thing to do. The regional director is one of the most senior public health professionals in the country, with specialist training and experience. As current informal health adviser, the regional director ensures that the Mayor has access to expert professional advice, which is based on evidence, to enable him to be fully informed when making decisions. The health adviser does not make decisions for the Mayor and the Mayor is under no obligation to accept the advice of the health adviser. The Mayor’s decision can be based on that advice, but those decisions need to be scrutinised, not necessarily the advice. That is an important point. Not only is the regional director the most qualified person to provide advice to the Mayor but, because she is accountable and works closely with the Department of Health and the strategic health authority in London, she also provides the Mayor with a link to both organisations. In practice, this enables the Mayor to play a strong role in influencing any health matters with strategic importance to London. That will be strengthened with the formalisation of this role. I have explained why I think it is right that the regional director should be the health adviser. My rationale applies to the deputy regional director as well. Amendment No. 29 should also be strongly resisted. It would give the Assembly the power to require the attendance of the health adviser and the deputy health advisers. As I said in Committee, they are civil servants and I do not think that that is appropriate. These professionals advise the Mayor; he does not need to take their advice. He makes his decision on the basis of that advice, and that is what should be scrutinised by the Assembly. Although it would be constitutionally wrong to place this requirement on the regional director as health adviser, in the past she has willingly attended meetings with the Assembly. I find it inconceivable that she would not do so in the future. The health adviser is an adviser to the GLA and will be as much the Assembly’s adviser as the Mayor’s. Clause 21 makes that clear. Finally, the noble Baroness, Lady Hanham, asked why the health adviser has to be the most senior public health professional. It is best that way; it will give London the best integrated professional advice. The system has been operating informally, which is a reason for doing this. The Memorandum of Understanding, which will continue, is between NHS London, the regional public health group and the Mayor of London on behalf of the Greater London Authority. I have not yet mentioned that the regional director of public health has a clear remit and job description and a strong record of working with the Assembly as well as the Mayor. On that basis, I hope that the noble Baroness will consider withdrawing the amendment.