Health and Social Care Bill

My Lords, I have added my name to the amendment, and I strongly support it. It is absolutely crucial that a public health specialist is a member of the NHS Commissioning Board. I note that protection and improvement of public health is one of the two crucial functions imposed upon the Secretary of State for Health by the Bill, and in several places. Three different bodies will be involved in discharging this function: the board, the commissioning groups, and local authorities. It is therefore essential that each has a public health physician at board level to do so. Effective commissioning requires expert understanding of populations and the diseases they might get, as well as their health needs and how these can best be met. There are major public health roles for the NHS Commissioning Board, including the direct commissioning of services, for which public health specialists’ expertise needs to be embedded in the board’s management structure. The NHS Commissioning Board will continue to manage primary care contractors, hold the population registers which make screening programmes possible—as the noble Baroness, Lady Finlay, mentioned—set the policy direction and operating framework of the NHS, and oversee major commissioning decisions and plan commissioning groups. Without a registered public health specialist as an integral member of the NHS Commissioning Board, national commissioning decisions will be made without an expert population health perspective informed by clinical and population-based data. It is critical that public health expertise informs all commissioning decisions and that commissioners have access to timely, reliable and relevant information and analysis. To meet this need, it is crucial that there is a registered public health specialist on the board of every health commissioning board, including the NHS Commissioning Board. There are other issues. Public health expertise within the service is also essential if the escalating costs of low-benefit technologies are to be controlled and the health service commissioners are to have the knowledge to implement the most effective and lowest-cost services. There should also be a duty placed on commissioning organisations to work with directors of public health and the public health teams on all commissioning decisions to ensure they meet the health needs of their communities. In addition, health impact assessments, and especially health inequalities impact assessments, are needed in all commissioning group investments in healthcare and in all clinical care pathway design. Where different care options exist, it is necessary to model which intervention will deliver the greatest health improvement for the lowest cost. Public health specialists are trained to do this, and to not have them at the board level of every commissioning body, including the NHS Commissioning Board, would be wrong. I know that there is a later amendment which proposes that, if there is a member of the executive or a civil servant with public health expertise on the board, the current amendment might not be necessary. I do not agree. I think it is absolutely necessary that the public health specialist on the board is there independently, to give an independent view.