Health and Social Care Bill

The director of public health has responsibility for what happens locally. One of the important issues here is the nature of the epidemic. The response to deal with that will be determined at the appropriate level—that is the key element in this. However, if the noble Lord and the Faculty of Public Health would like to engage further in discussions on this, I am extremely happy to offer that, knowing full well that my noble friend the Minister always has his door open. We look forward to further discussions to make sure that, where we feel it is working well but noble Lords need reassurance, we can address their concerns. The noble Lord, Lord Walton, brought me back to my history of medicine when he spoke about the history of public health. He emphasised the importance of training and the noble Lord, Lord Turnberg, emphasised education, training and research. I assure noble Lords that all training contracts will be honoured. We are exploring at the moment how public health trainee contracts will be managed in future and are engaging with those who are concerned in these areas. We will set up a stakeholder group of professional bodies, Department of Health policy groups, deaneries, employers and trade unions to develop a framework for supporting public health trainees. I trust that will reassure noble Lords. I completely agree with the noble Lord that the question of whether directors of public health will hold honorary NHS consultant status is very important and one that we are well aware of. We will shortly publish for consultation a public health workforce strategy to inform decisions on matters such as this. The noble Lord, Lord Turnberg, asked how directors of public health and Public Health England would work together. Public Health England will have local units to encourage collaboration that will be partners in local planning for public health and will help to join up the system. Public Health England will directly support the public health directors with evidence, guidance and best practice. I have addressed the senior status of public health directors and the manner of appointments, potential dismissals and emergencies. The noble Lord, Lord Beecham, includes the health premium in his amendment. I realise that he wanted to be extremely brief, so I will be extremely brief in reply and emphasise to him that we intend this premium to support the narrowing of health inequalities. I know—or at least assume—that his amendment is to probe and to find out how we view this. There will be a number of indicators to try to narrow those health inequalities. We do not want to see anyone disadvantaged by our proposals for conditions of service, and employment law will apply to staff who transfer. Last November, in partnership with employers and unions, we published best practice guidance for staff transfers, followed by further guidance agreed with the Local Government Association. Shortly, we will publish a wider workforce strategy for consultation. I thank my noble friend Lord Brooke of Sutton Mandeville for identifying a very important issue that has significant implications for a number of local authorities. The Bill gives local authorities a duty to take appropriate steps to improve the health of the people in their areas. As drafted, that duty does not have to be confined to people with a residential address in the area—it could, for example, include a homeless person who is sleeping rough in the area, or, as he says, those who might be working in a particular area such as the City of London. I can reassure the noble Lord that the current draft of the Bill would indeed allow local authorities to take steps to improve the health of people who work in an area or indeed of any other non-permanent resident. I also reassure my noble friend that we recognise the need for more work on how the needs of temporary populations are reflected in local authorities' funding. We are very grateful for the constructive discussions that the Department of Health is currently having with the City of London, which will continue and will help to ensure that the issue is resolved when final allocations are made. I hope that I have addressed noble Lords' concerns and am happy for us to have any further discussions, write letters and so on if there is anything else.