Health and Social Care Bill

My Lords, in Committee noble Lords made a number of helpful and constructive comments on public health. We have carefully considered this feedback, and as noble Lords will see in later clauses, we have made some significant changes to the public health provisions. Amendments 24 and 28 both relate to the Secretary of State’s accountability and his role in the promotion and improvement of health. The Secretary of State is under a duty to protect the health of the public in England. We are clear that the primary legal responsibility for health improvement should lie with local government, although the Secretary of State will have the power to act on health improvement when appropriate. We welcomed what the noble Lord, Lord Beecham, said in Committee about a renewed involvement of local government in public health, and he has reiterated that today. It is extremely important that local government, which is often best placed to take this forward, sees its prime legal responsibility and that there is no duplication of duties. Therefore, in drafting Clauses 10 and 11, we have taken care to avoid duplicating duties and to keep roles and responsibilities clear. We do not believe that additional amendments to the Bill are needed and I hope that noble Lords will understand why we have drafted these provisions in this way. Amendment 26 takes the list of steps that the Secretary of State may take as part of his health protection duty and turns it into a set of fixed duties. I hope that I can reassure noble Lords that the Secretary of State cannot simply ignore the steps even though we have used the word ““may”” and not ““must””. He must give proper consideration to what steps are appropriate to protect or improve health. Although the duty does not necessarily require the Secretary of State to take all the steps listed under new Section 2A, if after proper analysis he considers that a particular step is appropriate, he must take it. However, we take the view that the Secretary of State needs the flexibility to decide what steps are appropriate. The Bill outlines the areas in which the Secretary of State might take action. It fleshes out the ways in which the Secretary of State must take steps to protect the public. To prescribe these exemplars in statute runs the risk of inflexibility. One duty in the list, for example, is to make available the services of any person or any facilities. What would that mean if it was made a ““must””? Amendment 29 would set out specific public health issues that must be addressed by the steps taken under this duty. Although the amendment clearly indicates that the list is not exhaustive, it could still give undue precedence to the issues named; for example, by including occupational health but not smoking cessation. We agree that in certain circumstances some steps or services should be mandated, but we intend to do this through secondary legislation. I agree with the noble Lord, Lord Beecham, that the issues that he emphasised are important. However, I would refer him to the public health outcomes framework, which covers the areas comprehensively. I hope that noble Lords have seen that and will welcome it. The framework also gives indicators of how these areas can be evaluated. For example, the framework includes indicators on air pollution, fuel poverty and statutory homelessness. I hope that that fleshes out the intentions behind this legislation and that noble Lords will be reassured. In Committee, we discussed at some length the importance of reducing the harm caused by the misuse of alcohol. In the light of those discussions, Amendments 157 and 158, tabled by the Government, will ensure that a local authority with responsibility for health improvement will have a role to play in the licensing of premises for the sale and consumption of alcohol. We expect these functions to be the responsibility of the director of public health. A number of the amendments in this group address issues of co-operation that we also debated in Committee. We do not believe that further amendments to primary legislation are needed in this area. Local authorities are already under a duty to co-operate with NHS bodies in order to secure and advance the health and welfare of the people of England and Wales. The outcomes framework, which I have already referred to, will encourage further co-operation. It contains details of how the different levels of authority work with each other; for example, incentives for upper-tier authorities to co-operate and share resources—which was a concern of the noble Lord previously—with district councils. As the noble Lord is well aware, district councils are responsible for a number of services that have a direct bearing on the framework indicators—education and housing, for example. Amendment 32 would require the Secretary of State to publish a report on impacts of budget changes on health improvement. We discussed this proposal constructively in Committee, but the Government do not consider that such a specific amendment is needed. The Secretary of State will be under a duty to produce a report on the performance of the health service in England. Amendment 27 would require local authorities to take steps as appropriate to reduce health inequalities when exercising their public health improvement duties—the noble Lord, Lord Rea, also made reference to that. We have made amendments to require the Secretary of State to include in his annual report an assessment of how effectively he has discharged his inequality duty, which is an overarching duty applicable to the whole service. That would obviously relate also to local government. Therefore, do not feel that it is appropriate to make further legislative changes. We can also promote local authorities’ role in reducing inequalities in other ways. Again, I refer noble Lords to the outcomes framework, which takes a very wide view of public health and emphasises the need to reduce inequalities within that. If noble Lords look at the range of issues addressed within that framework, they will see that it is very clear that addressing these areas helps to address inequalities and that local authorities would not be carrying out their responsibilities appropriately if they were not seeking to achieve that.