Health and Social Care Bill

My Lords, I return briefly to the point that I made as an aside on an earlier amendment regarding the effect of local government. As this clause is drafted, it is absolutely clear that not all local authorities in England are public health authorities. It is quite clear that in the areas in England with two-tier local government, the powers and duties apply to the county councils and not the district councils. The county councils are in the same position as unitary authorities: they will be under the new statutory duty to improve the health of people living in their area; they will receive the new ring-fenced public health grant; they will be eligible to earn the new health premium; they will jointly appoint, with Public Health England, the director of public health; they will provide a place in each organisation for the director of public health; and they will operate the new health and well-being board. However, where the county councils differ from unitary authorities is that they do not have the environmental health workforce. That is with the district councils. This significant difference to the backbone of the public health workforce, which is directly controlled by local authorities, comes from the environmental health cadre. In England, there are 27 shire counties and 201 shire districts within those counties. There are 56 unitary authorities, 36 metropolitan districts, and 33 London boroughs, which of course includes the City of London. This amendment proposes that the Secretary of State and the public health authority shall promote co-operation between each of the authority’s relevant public health partners, which are listed in Amendment 75. The department is relying on localism. When I was in the other place, one of my boasts, rather than apologies, was that I was never a local government councillor. I love local government. It is independent and it makes a massive contribution to local democracy. But to be honest, I have never put it on an altar as a service deliverer or as a bastion of democracy. Localism, as defined and discussed, and some key issues such as public health and food safety do not go together. I have had agreement to this, even from LACORS. You are relying too much for public protection on the vagaries of all the pressures on local government. Localism and some of these issues do not go together. It is no good kidding ourselves that they will, because they will not. The noble Lord, Lord Ramsbotham, touched on that point and I am glad to reinforce it. The department is relying on localism to argue that the county and district councils will work together to make the appropriate arrangements for the delivery of public health services. Of course, it is right; there should be flexibility. Not all the areas of England are the same. There has to be co-operation. I repeat what I said earlier on: one size does not fit all. However, a statutory duty to co-operate does not dictate that councils should design their services—it just ensures that they co-operate in doing so. It is not always the case that different levels of local government are willing to co-operate. I have to say, regretfully, that it can sometimes depend on the personalities of the political leaders of the councils. People’s services should not depend on the personalities of the individuals in charge. There is no option available to local authorities not to co-operate with each other under this amendment. They have to work together to ensure this—but really they should be forced to co-operate. It must be in the Bill to protect those areas where personalities may intervene. The amendment is not limited to the relationship between county and district councils. It requires the public health authorities to co-operate with all the relevant public health partners, which are listed. That helps to embed the department’s requirement that local authorities should develop integrated services with other partners such as adult social services and voluntary and not-for-profit organisations. There are precedents in recent legislation for such a duty to co-operate. I have been advised, which I freely admit, by the Chartered Institute for Environmental Health. For example, in the case of safeguarding children, the relevant partners are required to co-operate with the children’s services. Again, in the civil contingencies legislation, category 1 responders are duty bound to co-operate with and support all other category 1 responders. This issue will not be dealt with today but we need to know the Government’s view in respect of this lacuna, almost, of treating England as though it is all a happy band of brothers and sisters and as though everyone gets on with each other in local government. Unfortunately, the two-tier mix is not planned. If England had a two-tier mix by design we might be able to have a better system, but it does not. It is almost an accident. My view is that it should be single tier, which I have probably implied. In Wales and Scotland in particular, the benefit of single-tier local government is clear for those Administrations. One way or another, Ministers will have to address this problem because it will not go away. I beg to move.