Health and Social Care Bill

Well, there we are—at this time of day, just before a recess, we have cross-party consensus. Shall we just adjourn? The noble Lord, Lord Greaves, correctly identifies the areas in which local authorities have done so much to improve public health. I made reference earlier, as others have made reference, to the 19th century, because the sanitary reform then was a local authority achievement, and it did more than the invention of antibiotics to save and extend lives. The devolution of public health to local authority-level aims to link up all those areas across people’s lives, a point emphasised by the noble Baroness, Lady Tyler. The noble Baroness graphically shows how health is related to wider social and economic factors, a point that the noble Baroness, Lady Hollins, has demonstrated in her account as well. I know from DfID how investing in girls’ education in developing countries results in later pregnancy. Why should it not be true here as well? My noble friend Lord Greaves asked whether local authorities will be able to draw upon funding at different levels. They will be able to pool and align budgets if this is the best route to improving health and well-being outcomes for local people. For example, when tackling drug misuse, local authorities may prefer a multiagency response. They may also want to consider pooling funding across local authority areas. Because they will need to demonstrate that the use of ring-fenced money is in line with grant conditions, this might well be most appropriate in some two-tier authorities. In response to the noble Baroness, Lady Hollins, and my noble friend Lady Tyler, I assure noble Lords that CCGs will play an active role in supporting public health. There are existing duties of co-operation between local authorities and NHS bodies which would be carried forward. To ensure that high-quality public health advice is made available at a local level, we intend through regulations to require local authorities to make sure that NHS commissioners receive public health advice. I hope that the noble Baroness will be reassured on that point. The intention underlying Amendment 75 is undoubtedly positive. Our difference with the noble Lord is restricted to how far it is necessary or desirable to use primary legislation to impose a standard model of the way that independent, competent local authorities and other agencies must relate to each other. We expect local authorities to take the leading role in co-ordinating local public health initiatives. This Bill supports that in a number of ways, for example by establishing statutory health and well-being boards. A number of noble Lords have highlighted the important role of district councils. We expect upper-tier authorities with new public health duties to work with relevant district councils. We believe that health and well-being boards will need to involve district councils, for the reasons that noble Lords have given. This will give them a vital role in driving forward local health improvement. However, placing all district councils under the same duty as upper-tier and unitary local authorities to take steps to improve the health of people in their area would again create an overlap between the public health duties of county and district councils. It would also complicate funding arrangements. Finally, I assure the noble Lord, Lord Beecham, that the invaluable and existing duties and responsibilities of local authorities will continue under the new system. Turning to Amendment 79A, I assure the noble Lord that CCGs already have the ability to commission services or facilities that they consider appropriate for the purposes of the health service that relate to securing improvement in the physical and mental health of the persons for whom they have responsibility; or in the prevention, diagnosis and treatment of illness in those persons. We do not believe that they need any additional powers to support integrated working. Amendments 203C and 215A will place new specific duties of health improvement on CCGs, which overlap with the duty of local authorities to take steps to improve the health of their population. The noble Lord, Lord Beecham, referred to that. While we expect CCGs and the NHS as a whole to continue having a significant role in public health—as I have outlined—we have been careful to avoid placing similar duties on separate agencies. The risk of confusion is too great. CCGs must obtain advice from persons who have a broad range of professional expertise, not just in the prevention, diagnosis and protection from illness, but also in the protection and improvement of public health. Clause 15 inserts new Section 6C into the National Health Service Act 2006 and confers two regulation-making powers on the Secretary of State. The first enables the Secretary of State to require local authorities to exercise any of his public health functions, and the second enables the Secretary of State to prescribe the steps that a local authority must take in the exercise of its health improvement duties or other public health functions. Amendment 89F would specify that the regulations made under new Section 6C could apply to local authorities or two or more local authorities acting jointly. I reassure noble Lords that the regulation-making power already allows sufficient flexibility for this to happen, and existing local government legislation already allows local authorities to perform functions jointly. My noble friend Lady Barker asked about the intervention of the Secretary of State. The Secretary of State is able to specify the particular public health services, facilities or other steps that one, several or all local authorities must provide or take. These are not powers that we expect the Secretary of State to use frequently or lightly, and we do not intend the list of prescribed services to become unduly long or burdensome. Nevertheless, there are some circumstances where it is appropriate to be more prescriptive. For example, we would consider mandating a step if the service or step needed to be provided in a universal fashion, if it was to be provided at all. As an example, we are considering mandating the weighing and measuring of children to ensure that local authorities undertake these functions and participate in the national child measurement programme. This is an example of a service that must be provided in a universal fashion, because sustaining a high participation rate within every area is essential to ensure a complete picture in terms of the national prevalence of childhood obesity. Besides the question of whether a service or step needs to be provided in a universal fashion, if it is to be provided at all, other principles apply where the Secretary of State is under a duty to provide a function but it is a function which we prefer to exercise at a local level, or where a step or service is critical to the effective running of the new public health system. I hope that that helps to clarify things for my noble friend. She does not look tremendously clarified, so we will no doubt come back to that.