Health and Social Care Bill

My Lords, we now come to the important area of public health. This is the time for your Lordships’ House to dip its collective spoon in the good part of this curate’s egg of a Bill. I have to say that, of course, in the context of this Bill, ““good”” is a relative term, but I very much welcome the reversal of the 1973 reorganisations—the splitting off of public health from local government—and the recognition, implicit and indeed explicit in the Bill, of the need for the closest possible relationship between public health services and the wide range of local government services which contribute to the promotion and improvement of the public health of individuals and whole communities. In this context, of course, it is critically important to recognise the need for a high degree of professionalism, and in particular to ensure that public health specialists are thoroughly engaged at a senior level within local government and that they have a considerable measure of independence, both at national and at local level. There are amendments that we will be discussing—not necessarily in this group but as we go through the Bill—that address those particular issues. One amendment in this group that I will not be moving or speaking to today is Amendment 94A, which relates to the making of Public Health England into a special health authority. By the vagaries of grouping, Amendment 267, in the name of the noble Lord, Lord Patel, relates to a later part of the Bill, although it could have been grouped with my amendment. It would be discourteous of me to anticipate that debate, given that the noble Lord’s amendment is down for future discussion. In general, we need to examine the role of government and their capacity either directly or through any of the other bodies created by the Bill to deal with the broader issues of public health at the local and national level. Amendment 60B is the first amendment in my name. It simply incorporates the concept of promotion of public health as well as protection and improvement of public health in the rubric to Clause 8. It strikes me as a more positive and perhaps wider responsibility, which is echoed in some of the amendments we will discuss in this group about promotion through information, publicity and the like. It also perhaps has slightly less of a strictly medical connotation than the original rubric contains. More significantly, Amendments 67A and 75ZZA relate to the proposed requirements on the Secretary of State to produce annual reports in dealing with the public health impact of budget changes and, as regards Amendment 75ZZA, in respect of finance generally. As ever, there is a significant issue around finance, which cannot be dealt with in terms of the context of the Bill. But it is critical that the reform is carried through with a workable system of financing the new arrangements. Considerable concerns about that have been voiced in response to the consultation documentation about funding the public health service from a number of quarters, including local authorities, the Faculty of Public Health and other organisations. The difficulties of course are that at the moment public health is funded through the PCTs. It is by no means clear what the total quantum will be defined as in terms of the money to be redistributed direct to local authorities—ring-fenced, as we know it will be—let alone how that quantum will be distributed by way of formula. In addition, there is the new concept of the public health premium which will be used to reward those authorities which achieve an improvement in the public health of their area. These are difficult matters. The Select Committee suggested that the public health impact of financial changes should be the subject of report. Both amendments simply follow the recommendations of the Health Select Committee of the House of Commons. I hope that the Minister will be able to agree them or at least agree to consider them and come back on Report. I have been looking into this issue with the Local Government Association and this morning I received some advice stating: "““We are no nearer an announcement on the distribution formula or quantum after the third trawl for data. We remain concerned that it may be dealt with in isolation from wider issues about the design of the wider systems and the role and cost of Public Health England””." Clearly, the finance will not be dealt with in the Bill but we need to know as we go through the Bill and approve—I hope improve—the proposed structures, how the financial system would work. Perhaps in reply the Minister could give an indication of when it would be expected that the financial framework will be explained and judgments might then be made about the adequacy or otherwise of those arrangements because they will impinge heavily on the eventual outcomes that we are all seeking. Amendment 69ZA will extend to local authorities the duty to have regard to and promote the health equalities agenda, which we have discussed previously in relation to the national Commissioning Board and the national players, as it were. It seems to me sensible that there should be a matching requirement for local authorities to have particular regard to that issue. Amendment 89A is a suggestion, really, that the provision in the Bill conferring on CCGs the responsibility of arranging vehicles for residents who need them could also be a concurrent function of local authorities, some of which, I think, currently operate such schemes. Given the arrangements that local adult services and, indeed, children’s services of departments already have for supporting people with conditions requiring such mobility, it would seem sensible to permit those to be included in the arrangements. I hope that the Minister will respond sympathetically to these amendments, and indeed to others that other noble Lords will be making in the debate this afternoon. If he cannot reply in detail today, as time is pressing, I would quite understand if written communication were made later.