Health and Social Care Bill

The noble Lord flags up a concern that has been expressed about the independence of the new organisation. I would point out the example of the Met Office, which is arranged in a similar way. What it does on climate change may not always go down well with the Government of the day, yet it has no reluctance in coming forward with the evidence that it has. It is extremely important that it should have that expert advisory position. That is why it was moved out of the Department of Health, which was the original proposal. The noble Lord will know that it was going to be within the Department of Health, but the Future Forum flagged up that concern and the decision was taken that it be arranged in this way, to address the points that the noble Lord has raised. Coming back to what I was saying about the Health Protection Agency—I remind noble Lords that Clause 53 abolishes that agency and repeals the Health Protection Agency Act 2004. That is central to the Government’s plans for unifying national health protection activity and creating a more transparent and accountable service under the Secretary of State. In so many ways the Health Protection Agency has done an outstanding job, and we certainly pay tribute to those who have worked within it. It has established an outstanding international reputation, as the noble Lord, Lord Turnberg, pointed out. Public Health England will be able to build on that recognised expertise not only from the Health Protection Agency but other organisations that we can draw into our public health system. There was talk about whether this should be a special health authority. The noble Lord, Lord Beecham, said that he wished to address this later on, so no doubt we will come back to this and to the points the noble Lord, Lord Warner, made about independence and why we are not proposing to do things in quite that way. Clause 50 requires the Secretary of State to publish an annual report. Noble Lords wanted to know about the reporting mechanisms. This annual report covers the performance of the comprehensive health service in England. I wish to highlight that the content of the report will include public health. The noble Lord, Lord Warner, was right to emphasise the importance of good evidence. This will be key to the analysis and taking forward of effective policy. I understand exactly what he means by ““special interest””. However, the drafting of his amendment might have the unintended consequences of people not being able to consult groups that they might wish to consult—such as the royal colleges, which might be regarded as being special interest. The key thing here is not only the commitment to rely on scientific evidence but also transparency. That is essential. If you have transparency over where information is coming from and who is meeting whom, that should help to allay some of the concerns that the noble Lord has expressed. We have heard a certain amount about medical records. The Department of Health’s information strategy, which will be published this winter, will include consideration of the benefits of greater transparency of provider performance and outcome information as well as setting out how increased transparency and greater access to information can support improvements in care, giving people greater access to and control of their care records. A number of noble Lords raised the point about their medical records. This has been a long and ongoing debate over generations, almost. I hope that noble Lords will be encouraged by what comes forward. Clause 9 inserts new Section 2B into the National Health Service Act 2006, giving local authorities a new duty to take steps to improve the health of people in their areas and the Secretary of State the power to take steps to improve the health of England. There has been a bit of a debate as to the balance here. As noble Lords will recognise, there is undoubtedly a shift in the devolution of the responsibility to local authorities. We welcome the enthusiasm that has been shown by local authorities and the Local Government Association in taking on this responsibility, which belonged to local authorities in earlier years and made such a dramatic improvement, particularly in the 19th century in terms of sanitary reform when it was at local authority level that enormous change took place. It is easier to see the joining-up of all the areas that need to be joined up, as shown in the Marmot report, if public health is seen as a local authority responsibility. Giving this role to local government opens up new opportunities for community engagement and for developing holistic solutions to health and well-being by embracing the full range of local services. Crucially, unlike primary care trusts local authorities are also directly accountable to the local electorate for their performance. Directors of public health will lead this work as the principal advisers on health to the local authority. I hear what the noble Lord, Lord Beecham, says in regard to inequalities. However, I hope to reassure him that our reforms will give all levels of the public health system key roles in tackling health inequalities. The shift to local authorities should help in this regard. As these changes take effect, we would expect them to have the largest and earliest impact on those communities with the worst public health, by joining up services in that way and because the public health budget will be ring-fenced for local authorities and therefore will be less likely to be raided by the rest of the health system. The Secretary of State for Health will publish a public health outcomes framework that will set the strategic context for the system from local to national level. The framework will set out the broad range of opportunities to protect and improve health across the life course and to reduce inequalities in health. As I mentioned, from 2013-14 the department intends to allocate to local authorities a ring-fenced public health grant, targeted for health inequalities. We are also developing a health premium to reward communities for the improvements in health outcomes that they achieve. The noble Lord asked when funding for local authorities would be made. We expect to announce a baseline figure for 2012-13 very shortly, which will allow local authorities to plan ahead for 2013. Our estimate of the global figure, as he will know, is in excess of £4 billion. Amendments 69A and 60B would effectively give the Secretary of State a duty in relation to health improvement. In drafting Clauses 8 and 9, we took care not to duplicate duties as this could inadvertently create confusion over whose responsibility it is to act, by giving two agencies a duty to take similar steps. This is an area that the noble Lords, Lord Beecham and Lord Warner, and others probed. I hope that this clarifies that we are devolving responsibility to local authorities, with certain responsibilities for the Secretary of State and Public Health England. In addition, there have been a number of amendments in relation to the steps that may be taken under parts of new Sections 2A and 2B. We have avoided defining health protection or health improvement in a restrictive way. Instead, these steps illustrate the nature and extent of the functions by listing a number of steps that the Secretary of State or local authority may take. In some cases, we have also selected the steps to remove any doubt as to whether they could be taken in the exercise of the new functions. Clause 14 transfers responsibility for a number of public health activities from the Secretary of State, including the transfer to clinical commissioning groups of the Secretary of State's responsibility for the supply of wheelchairs. This issue has not come up; noble Lords seem to be relatively content. I hope that, if they are concerned, they will make contact in time. Clause 19 allows the Secretary of State to delegate by arrangement his public health functions to the NHS Commissioning Board, clinical commissioning groups or local authorities. Where the Secretary of State enters arrangements under new Section 7A, the function will remain that of the Secretary of State, but it will be exercised by the body that is under and subject to those arrangements. When a local authority, the Commissioning Board or a clinical commissioning group exercises the Secretary of State's public health functions, it will be liable for its own acts or omissions. However, the Secretary of State will remain responsible for the function in the sense that he will be accountable to Parliament and will have to check that continued delegation is appropriate and that the function is being exercised appropriately. The noble Baroness, Lady Finlay, spoke about ““and”” and ““or””. I assure her that the provision is expressed in a non-excluding way. I know that ““chair and table and desk”” appears to mean that you have everything, but if you put in ““or”” it makes it easier: if you have a chair and table, you are not ruled out if you do not have a desk as well. I hope that the noble Baroness is reassured. When I sought explanation about when to use ““and”” and ““or””, it was explained that having ““or”” makes a provision more inclusive than having ““and””. Therefore, the noble Baroness can be reassured that we are not going down the line of wanting treatment with no diagnosis. I cannot imagine that the medical profession would agree to that even if we were to propose it.