Health and Social Care Bill

Lord Brooke of Sutton Mandeville Excerpts

Wednesday 29th February 2012 Lords Chamber

These examples illustrate the tensions that are as yet unresolved in the design of the new public health system. While I am absolutely delighted with the document the Government have produced, there is some way to go in making sure that we do not fall through this lacuna again about the preparedness for the health of the local population. If the noble Baroness is not minded to accept these amendments—and I will not be surprised if she is not—perhaps she might accept that there is an issue here to be addressed. One way might be to push for a vote, but I am not going to do that. I would much rather she accepts that there is an issue to be addressed here, and is willing to work with the Faculty of Public Health to make sure that the appropriate mechanism is put in place.

[Lord Brooke of Sutton Mandeville]

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.