Health and Social Care Bill

Baroness Cumberlege Excerpts

Monday 5th December 2011 Lords Chamber

[Lord Beecham]

Perhaps the Minister, if not today then subsequently, could address her mind to the significant issue that I raised about the positions of directors of public health and district councils. Her assumption, which is fair enough at the present stage of the Bill, is that to all intents and purposes Public Health England and the Secretary of State are one. It is a political version of the theological concept of consubstantiation. I understand that, but that assumes that Amendment 260, which calls for Public Health England to be a special health authority, will not be approved. If it were approved, what would the Government’s position be on the question of joint appointments and consents that under the Bill at the moment would lie in the hands of the Secretary of State? At that point, Public Health England would not be the special health authority. I am not asking for an immediate answer, but if the amendment were to be approved—and I certainly hope it will be approved in due course—would it be Public Health England in those circumstances or would it be the separate Secretary of State’s role to adjudicate on those matters?

[Baroness Cumberlege]

I thought we were going to debate Amendment 260 later today and I would like to take part in that debate when we come to it in the groupings.

[Baroness Northover]

I thank noble Lords for being so willing to receive letters about the areas that they are concerned about. I found myself retrieving what I learnt in my history degree, and I suppose this then becomes the Reformation. I will ensure that we write to noble Lords about these areas.

Health and Social Care Bill

Baroness Cumberlege Excerpts

Wednesday 16th November 2011 Lords Chamber

[Lord Clement-Jones]

My Lords, from the outset the noble Lord, Lord Warner, and my noble friend Lady Williams have hit the button on this debate. Like the noble Lord, Lord Warner, I am a sceptic about nudge theories and think that they need to be investigated. I thought that the House of Lords committee under my noble friend—my former noble friend—the noble Baroness, Lady Neuberger, interrogated the issue extremely well. We are in an obesity crisis. We are expecting 50 per cent of adults to be obese by 2020 and I believe that we are going to have to do something rather more drastic than simply nudge people. Personally, I am quite attracted to the idea of a fat tax. Let us see the evidence of whether a nudge is going to prevent us from facing a major obesity crisis by 2020 that is even greater than the one that we already have, or whether a fat tax is the only way that we are going to get there. The spirit of the amendment moved by the noble Lord, Lord Warner, is absolutely correct in that respect.

Very ingeniously, the noble Lord has introduced the idea of patient control over their own records. I do not know whether this is the right place in the Bill to be debating this issue, but I do know that it is an extremely important suggestion. Patients should have control over their own records, which should not be simply under the control of the local GP. It is increasingly important for pharmacists to have sight of a patient’s records—with the consent of the patient; that is the essential control—and that other healthcare professionals should do so. There should not be a monopoly on the sight of patients’ records for general practitioners. With the consent of patients, other health professionals should be able to see them. We will then have proper integration of healthcare without expecting GPs to be the gatekeepers for all an individual’s healthcare needs.

I do not know whether we are starting the debate that was referred to at Second Reading, but this is an important area which I hope will be discussed further during the course of the Bill.

[Baroness Cumberlege]

My Lords, I should like to make a short intervention to ask my noble friend one or two questions. When I was a Minister I was responsible for the Health of the Nation policy, which I much enjoyed. At the time we introduced the five-a-day programme. That was 21 years ago, so we can see how long it has taken to get that message deep into the psyche of the British people. There is something about promoting good health and habits of living to the population—it takes a very long time.

I want to speak to Amendments 62, 65 and 68. I was very much hoping that we would have a debate on Amendment 94A, which is about Public Health England. But courtesy is the hallmark of this House and, as the noble Lord, Lord Patel, is not here, it is absolutely right that we should not debate it today.

On Amendment 62, on scientific and other evidence, from the noble Lord, Lord Warner, it is the “other evidence” that I want to ask my noble friend about. As my noble friend Lady Williams said, other evidence is something that you build up, and I am quite concerned about how we are going to get this evidence into health and well-being boards and how we will ensure that the Government have enough evidence that builds from the bottom up. One problem is with access to data; if we are going to have joint needs assessments through the health and well-being boards and strategies, and if that information on the ground cannot be shared, it will be very difficult to ensure that we have joint needs assessments. The GPs have those data and share them with other people in the National Health Service, but I do not believe that at this time they can share them with local government. That will be a very important issue because, although they are anonymised data, if you are going to run a public health programme on obesity you really need to know exactly in what geographical area that obesity is at its worst so that you can target it. When you are looking at the needs of individuals, you may have information about the numbers of people who have diabetes or coronary heart disease, but it is when you link those diseases to individuals that you get back to the previous debate that we were having on long-term conditions. Linking some of this stuff together is absolutely critical, and maybe my noble friend could think about that in the intervening time and write to me—and to other noble Lords, if they are interested.

I agree with my noble friend Lord Clement-Jones that this may be not quite the right moment to discuss medical records, but I really cannot resist it, although I will be brief. Some 21 years ago, in this House, from the place where my noble friend now sits, I made my maiden speech on medical records, so it is something that I have quite an interest in. When I produced a policy document on changing childbirth, one recommendation was that women who were pregnant should hold their own medical record, sometimes known as hand-held maternity notes. That has had an enormous impact; it has made those women feel that they are very important—they are pregnant and they are going to have a child and a whole readjustment to family life. That is a very important time in a woman and her partner’s life, and it acted as a sort of passport to them. Bearing in mind that 30 per cent of women who are pregnant are obese, which has a huge impact on the next generation, it seems to me that having hand-held records or access to or ownership of your own records is terribly important. Of course, we have the red book that women get about their children so that they can share that information with health professionals.

My last point is on Amendment 68 and the standing advisory committee. I absolutely understand why the faculty of public health and other people like that idea. I am not sure whether that advisory committee, as has already been suggested by the noble Baroness, Lady Finlay, will make an annual report. That is possible. We will have the Chief Medical Officer’s report annually, as she said, which is a very brave and independent document; the Chief Medical Officer says how it really is, and I know that it is very often extremely uncomfortable for the Government.