My Lords, I want to take the opportunity of this debate, arising from the dissolution of Public Health England, to pay tribute to PHE and its chief executive, Duncan Selbie. I also want to ask the Minister to tell us more about the Government’s intentions regarding public health, a matter that certainly deserves consultation, as my noble friend Lady Merron has insisted, and more than the perfunctory scrutiny—or non-scrutiny—normally given to a statutory instrument.
With other parliamentary colleagues—including a good number from your Lordships’ House—in the All-Party Parliamentary Group on Arts, Health and Wellbeing, I worked for some years with Mr Selbie and others in his team at PHE. At a time when the Department of Health, NHS England and clinical orthodoxy were far from recognising the significance of the well-being agenda, social prescribing and the potential of the arts to support health and well-being, PHE was positive and far-sighted. During the three-year period of the inquiry which led to the publication of the APPG’s report, Creative Health, in 2017, PHE worked constructively and thoughtfully with us.
The three key messages in Creative Health, underpinned by evidence, were that the arts can help keep us well, aid our recovery and support longer lives better lived; help to meet major challenges facing health and social care, including ageing, long-term conditions, loneliness and mental health; and help to save money in the health service and social care. Duncan was one of a number of distinguished people, including Professor Sir Michael Marmot, who publicly endorsed the findings of Creative Health. He said:
“This is an impressive collection of evidence and practice for culture and health”.
The publication of Creative Health was, I think it is fair to say, a turning point in the recognition by the health establishment of the importance of social prescribing and the engagement of individual creativity in promoting health and well-being.
In a speech at the King’s Fund in November 2018, the then Health Secretary, the right honourable Matt Hancock, explicitly acknowledging the significance of the Creative Health report, said that from now on prevention must be fundamental to NHS strategy and social prescribing must be fundamental to prevention. He stressed the value of the arts and culture in social prescribing, and the NHS Long Term Plan of 2019 reaffirmed the centrality of prevention. Mr Hancock established the National Academy for Social Prescribing later in 2019.
Much has happened since then. While I can well understand that the new Secretary of State is preoccupied with Covid-19, the clinical backlog that Covid has so much worsened and the pressures on the NHS workforce, I would ask the Minister to reaffirm that the Government’s commitment to their prevention strategy is not diminished and that they continue to recognise the importance of personalised health and of the arts and culture in contributing to health and well-being.
I hope the Minister will also pay tribute to Duncan Selbie and PHE. When it was announced that PHE was to be abolished, I was shocked. It was hard not to believe that PHE institutionally and Duncan Selbie personally were being scapegoated for the Government’s own failures in the early stages of the pandemic. Of course, I wish the successor institutions well and look forward to working with them through the APPG and the National Centre for Creative Health. It is a shame, however, that Mr Selbie was cast aside.
I am concerned that the “build back better” plan envisages shifting the NHS towards prevention only as a long-term priority. However, integrated care systems surely offer an early opportunity for the NHS to work better with local authorities and the voluntary and community sector, including arts providers, on prevention. Will the Office for Health Improvement and Disparities be working with other government departments responsible for education, housing and employment in addressing the social determinants of health?
I hope we can be reassured this evening that the Government recognise their error in having reduced the public health grant by no less than 24% per head over the last six years, with terribly damaging consequences, and that the restructuring that has now occurred is intended to provide more, rather than less, support for public health.