Health and Social Care Bill

My Lords, I shall speak to Amendments 203C and 215A. Although the Bill places a duty on each clinical commissioning group to, "““obtain advice appropriate for enabling it effectively to discharge its functions from persons who (taken together) have a broad range of professional expertise in … the protection or improvement of public health””," it places no duty on clinical commissioning groups to act at all times with a view to the improvement of public health. Such an omission will render the delivery of public health outcomes significantly less likely, with clinical commissioning groups free to act without regard to the wider public health needs of the populations they serve. The Government’s intention to leave public health—and therefore public mental health—entirely to local authorities could mean that the opportunity will be lost for clinical commissioning groups, local authorities and national agencies to work in consort to achieve better outcomes. There is a fundamental relationship between mental health and well-being and almost all other aspects of individual and public health. Handing responsibility for public mental health solely to local authorities could have deleterious consequences for achieving good outcomes in public health more generally unless precautions are taken. The purpose of these two amendments is to try to mitigate the consequences of this decision. They would ensure that clinical commissioning groups are required to act in such a way that they contribute to the improvement of public health—and public mental health—and are required to demonstrate in what ways their actions fulfil such an obligation. I should also like to add my support to the amendment of the noble Baroness, Lady Tyler. I was unable to participate in the discussion about the previous group— where perhaps the comments I am going to make might have been more relevant—because of a commitment to speak at the same time to an amendment in Grand Committee to the Welfare Reform Bill, due to the rather unfortunate timetabling of that Bill. The point that is relevant here as well is that public health relies on the relationship between so many different agencies, and I am thinking here particularly about the contribution made by education. The example I want to give is about the health of the next generation, which relies so much on the way in which children are parented. Education and support for future parents seems such a worthwhile investment. I want to give just as an example the work of the charity Teens and Toddlers. It does not work by telling teenagers to change their behaviour, because that does not work; it offers them a holistic and transformative experience which has a much greater effect. It really is a health intervention as well as an educational one. The programme allows teenagers to spend two hours a week for 15 weeks looking after a toddler in a nursery. They also spend time talking through what that experience has taught them. What is so extraordinary is the effect of the programme, which is now available in 12 London boroughs and 13 other areas of the UK. Some 97 per cent of those who graduated from the programme have not become pregnant before the age of 20, and 92 per cent have continued in employment, further education or training. I am sure that the Minister will agree that public health is so much more than the responsibility of only the local authority and the NHS.