Health and Social Care Bill

I have put my name to Amendments 328B and 330ZAA. I send the apologies of the noble Baroness, Lady Tyler, who is not well. She had hoped to be able to speak to these instead of me. First, I should like to make a few general points about health and well-being boards. It should go without saying that the Liberal Democrats really welcome local democracy in health and the far greater involvement of local authorities than is the case at the moment, as well as the use of scrutiny committees. We are somewhat saddened that in the legislation there is only one elected decision-maker on a health and well-being board. I understand the Government’s unwillingness to prescribe, but they have not quite got the balance right. There may be as many elected councillors as other voting stakeholders, with maybe a casting vote given to the chair. That feels much more like localism in action than what we currently have. Linked with that is the role of district councils, which is not mentioned terribly clearly. Here I have another apology, because I know that the noble Lord, Lord Greaves, had hoped to speak on this point. What we are losing in his eloquence we are probably making up for in brevity, but I still feel as strongly as I am sure he will. I can almost feel him behind me now, as I speak, but he is not well and is not able to be with us. Where are district councils in this framework? I know that a lot of local authorities have now become unitary, but there are really key parts of England where strong county councils are well underpinned by district councils. They need to be there, because they provide planning, housing, leisure and environmental health—all these things that have to be well woven into the fabric of this Bill and the delivery of services. They are also part of the solution for the big public health issues. Three examples come to mind without even having to think very hard. Wearing their leisure hat, obesity is a very big issue. Some people prescribe exercise for obesity. On housing, in my neck of the woods, with the warm, wet westerlies, housing gets damp very easily. That brings with it chronic heart and lung problems, particularly if you cannot afford to heat. District councils also play a key role in housing on mental health issues. They are often providers for county councils and PCTs and I know that they would hope for a similar relationship with clinical commissioning groups, when things become established. They should be at the table of the health and well-being boards. I appreciate that you cannot have every district council having one representative. In Kent, where there are 16, or in Devon, where there are eight, you cannot bring those in, but there needs to be some arrangement for working together to ensure that district councils should be there. My amendments relate to housing, in Clause 190 on joint health and well-being strategies. Their aim is to ensure that all health and social care needs are considered, alongside what might be called regular housing needs, in preparing planning strategies. Right up front, when councils are determining their planning, those few—or perhaps not so few—that do not have health on the list of things that they are considering should consider the impact that housing provision can make to health. Their planning strategies cover social housing, whether run by councils or outsourced, but housing should also play a role in putting together health and well-being strategies. It would be really good, where it does not currently happen, for the DPH to be working alongside planning departments to think about how this might pan out. Housing associations have huge expertise to offer to health and well-being boards in planning for the elderly, the vulnerable and chaotic families. They see them and work with them. For the vulnerable and elderly, telecare, heating, dampness and appropriate aids are issues that have huge positive impact on health. They are currently not always seen in that context. They are seen as something that has to happen when these groups live in social housing, but they are not always necessarily seen as health-related, although they should be. Earlier in the Committee we moved a couple of amendments that were aimed at strengthening health and well-being boards’ and clinical commissioning groups’ thoughts around children, so I really welcome the amendment of the noble Baroness, Lady Massey. I would be grateful if my noble friend the Minister could give the Committee some clarity on democratic representation—adding councillors to health and well-being boards, but also ensuring that there is explicit district council representation on the board—and on the involvement of planning departments and social housing providers in producing health and social care plans.