Health and Social Care Bill

My Lords, I shall speak to my Amendment 122A. The aim of this amendment is to probe the intended scope of local authorities' public health obligations, with particular reference to areas that are primarily business in character. It does so by seeking to make clear that the directors of public health to be appointed by local authorities and the Secretary of State under this clause will have health responsibilities for those working in their authorities' areas as well as for residents. It may come as no surprise to your Lordships that I have in mind the constituency which I represented in the other place for 24 years, and particularly the eastern portion of it comprising the City of London. The Bill, through an amendment to the National Health Service Act 2006, envisages that county councils, unitary authorities in the rest of England and London local authorities will be given an additional function: improvement of the health of their communities. In the words of subsection (1) of new Section 2B of the 2006 Act, inserted by the Bill: "““Each local authority—" the authorities I have just referred to— "““must take such steps as it considers appropriate for improving the health of the people in its area””." As to the discharge of that function, Clause 29 inserts a new Section 73A into the 2006 Act. That will require the local authorities in question, acting with the Secretary of State, to appoint a director of public health. If I may paraphrase the statutory language for a moment to describe the practical consequences of these provisions, the director of public health will be responsible for securing improvement in the health of the people in the local authority's area in accordance with the policies that are adopted by the local authority or otherwise apply there as the result of national health policies. The scope of the function conferred on local authorities, and through them the responsibility on directors of public health, will of course depend on who is taken to be included in the description of ““people in the local authority's area””. I am taking the liberty of assuming that this may be taken to include the people who actually live there, but of course there are people other than residents there too. My amendment aims to recognise the fact that the resident population in an area of an authority may be matched or even dwarfed by a non-resident population. As I have already indicated, the example I have in mind is the City of London, where, as your Lordships are aware, the resident population is very small in comparison with the daytime business population. An indicator of relativity is provided by the current parliamentary register of electors, which records around 6,500, against an estimated daytime business population of 360,000, according to the Office for National Statistics in September 2011. My erstwhile constituency mailbag bore witness to that army. While my focus is on daytime business populations, I acknowledge that other areas may also experience wide variations in what might be described as their permanent residential populations and their temporary ones. The western portion of my former parliamentary constituency, the southern part of the City of Westminster, has a substantial business component but also many tourists and daytime visitors. At an election, if I spoke to someone at random in the street, I had a one in 15 chance of speaking to an actual elector of my own. Seaside resorts have large temporary populations in the summer. The tourist and daytime visitor populations are, of course, more transitory than daytime business populations made up of people who come during the day, week by week, to the same location, and are not simply transitory. Nevertheless, even visitor and tourist populations would seem likely to generate some public health issues, which may prompt similar questions of scope of the public health functions to the one I am raising here. I return to the City of London. The City's non-resident population is best characterised as a settled business community. The public health responsibility might therefore be expected to reflect that settled status. The Bill does not, however, indicate whether, or to what extent, the responsibility under the Bill extends beyond resident populations. There are situations in which public health issues might be encountered in people's workplaces rather than at home. Stress-related problems may be one and smoking another. I do not lay claim to a detailed knowledge of workplace public health issues, but noble Lords will, I hope, appreciate the general point of scope which I am making. Scope will, of course, in turn ultimately be relevant to the funding demands generated by the responsibility to be discharged by directors of public health appointed under Clause 29. I should mention in passing that the question of how far local provision should service the needs of daytime as distinct from residential populations has been raised in other health contexts. It is, for example, reflected in the start of trials to open up registration at GPs' surgeries not only to local residents but also to local workers. This trial is being run in the City of London and certain other areas, including Westminster and Manchester. As to the form of my amendment, the aim is, as I alluded to your Lordships in opening, to make clear that a local authority's public health function extends to those working in its area as well as its residents. This is achieved by an additional subsection in Section 73A of the 2006 Act dealing with the appointment of directors of public health, which is inserted by Clause 29. I am aware that discussions have taken place between officials in the City and the Department of Health. I should make clear that I make no criticism of those, which I understand have been helpful. I hope, however, that my noble friend will feel able to take this opportunity to say a little more about the application of the public health function to daytime populations, such as the business community in the City.