Health and Social Care Bill

My Lords, I shall turn to Amendment 75ZA in my name in a minute. First, I congratulate the noble Lord, Lord Rooker, on putting his finger on the extremely important issue of the role of district councils where there is a two-tier local government system. I do not agree with everything that he said about local government but I agree with a great deal of what he said about the problems that we have. This legislation is designed for unitary authorities—metropolitan districts, London boroughs and the unitaries in the rest of England. The Government do not seem to have thought out exactly how it will work in two-tier areas. This is not an issue of principle or challenge to the Government. It is an attempt to make this system work better in practice when it comes in. My amendment would remove the provision in the Bill that deletes shire districts from the definition of local authorities in new Section 2B to be inserted in the 2006 Act under Clause 9. I would argue the case for that but the noble Lord, Lord Rooker, suggests that co-operation and partnership is the way forward. My noble friend Lady Tyler has put forward an interesting amendment about the role of CCGs in local government functions and how that might work. There are other ways of looking at it. I sincerely ask the Government if we can have discussions between now and Report to thrash this issue out properly. In a sense, it is a technical matter but it may not work. In replying to previous amendment, my noble friend Lady Northover said that we have to join up all the different areas that affect public health. The crucial word is ““affect”” because there is no doubt that a great deal of what district councils do affects health. Like the noble Lord, Lord Beecham, I am sadly old enough to have been on a local authority committee, which was a municipal borough, in Colne before 1974. It was the housing and health committee, which received regular reports from the medical officer of health. The public health authorities at that time were the lower-tier authorities. While they have problems of resources and the ability to do things, again in the words of my noble friend Lady Northover, they have local insight and expertise, which has to be tapped into. District councils carry out some duties. The Labour Front Bench amendment, which refers to retaining existing duties for districts, is important but it is an absolutely minimalist approach. A huge amount of what district councils now do are things that they do not have a duty to do but which they have taken on because there were problems and things that needed doing. They do it because they have powers but not necessarily duties. Housing is crucial and there are still many council houses. If you are looking at listing the two or three main public health improvements which have taken place in this country in the past 100 years, the massive provision of council housing for 50 years of that time must be near the top of the list. They provided people with decent homes, decent environments and decent estates when previously they had lived in appalling slums. This has been a huge achievement, yet it was not a public health achievement; it was a housing achievement. Even now, they have their strategic role as housing authorities, which is very important even if they have pushed away their council housing to other organisations. Over the past 100 years the improvements in public health are down to improved housing conditions. Even poor housing conditions nowadays are usually immeasurably better than they were 100 years ago. This is all down to the work of local authorities. A huge amount of work still has to be done, particularly with the bottom end of the private rented sector—the sort of areas I know too well in my own ward. All this kind of work is lower-tier local authority work. It encompasses the whole environmental health regime, which noble Lords have talked about, from food inspections to dealing with pollution and air quality. A huge improvement in public health was led by the introduction of the Clean Air Acts, which have made air breathable when, as many of us remember, it was hardly breathable. So local authorities tackled air pollution and air quality. Indeed, they are responsible for all sorts of things, such as contaminated land and pest control licensing. Of course, the lower-tier authorities are also responsible for enforcing the legislation on the prohibition of smoking in enclosed public spaces and for the whole operation of street cleansing and refuse collection—litter, dog fouling and tackling graffiti. You might think, ““What has graffiti got to do with public health?”” If you live in a neighbourhood that has been allowed to become run down, people are allowed to spray graffiti where they want and the whole place is rotten, the effect on people’s quality of life and their mental health is huge. The whole of planning is about public health in many ways—the built environment, the nature of the built environment, the provision of facilities and the regeneration of areas. Leisure services and facilities, playgrounds, parks and the whole of the public realm have a huge effect. If people enjoy living in a town, a village, a suburb, a neighbourhood or wherever they live, if it is a pleasant place to live in and enhances their quality of life, their basic health will improve. The council may provide parks, playgrounds, sport and recreation activities, sports development activities, indeed the whole leisure field. However, a great deal of what local authorities do is discretionary. In recent years, district councils particularly have taken on a lot of work on behalf of other authorities. They have been funded by PCTs and other parts of the health service, by central government and by other sources. I will briefly mention some of the projects that are going on in my own area of Lancashire at the moment: living and eating well schemes, run by the leisure trust; stop-smoking schemes; healthy workplace schemes; suicide prevention; intensive family support schemes; and schemes to reduce infant mortality by encouraging young women having children who otherwise would not go to prenatal classes to attend them and by putting them in touch with professionals. Things such as the provision of cycle racks may not appear to have anything to do with public health but, when you think of it, it is obvious that these are practical local schemes. Many such schemes are not very expensive but they are being funded at the moment through the PCTs, the health service and other bodies, and it is crucial that these kind of schemes continue. I repeat the point I raised earlier about resource allocation. If this new system results in the district councils—the lower-tier authorities in two-tier areas—losing their funding, a lot of these schemes will not exist. What we need in all these areas is an audit of existing resources, an audit of what goes on at the moment and some kind of duty on the upper-tier authorities that will receive a lot of this money to pass the money to the district councils for appropriate schemes in appropriate places. I do not know the best way of writing district councils’ roles and opportunities into the Bill, but I am absolutely clear that they have to be there. The present situation, in which all the Bill does is to strike them out and say they are not here in relation to public health, is not acceptable. So I ask the Minister whether we can have some discussions between now and Report stage to get this sorted out, as it is very important.