Health and Social Care Bill

Debate between Lord Rea and Baroness Northover

Monday 13th February 2012 Lords Chamber

[Lord Rea]

My Lords, I do not know if it is a slight slip on the part of those who drafted the Bill that the word “promotion” is not already in the clause. The coalition agreement on public health states:

“The Government believe that we need action to promote public health, and encourage behaviour change to help people live healthier lives … harnesses innovative techniques to help people take responsibility for their own health”.

That is a bit unfair on people because lifestyles are very much dependent on life chances. People who come from a rotten background may indulge in practices which are not particularly good for their health, but you cannot really ask them to change. We need to take into account a lot of the things which my noble friend Lord Beecham has just gone through because they are relevant to the practice of public health. The word “promotion” should definitely be included at the beginning of this clause.

[Baroness Northover]

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”?

Population Growth

Debate between Lord Rea and Baroness Northover

Monday 13th December 2010 Lords Chamber

[Lord Rea]

My Lords, I think that the whole House will be grateful to the noble Lord, Lord Hodgson, for raising this Question and for his thoughtful and thought-provoking speech. The fact that 11 speakers have put their names down for this one-hour slot gives an indication of the importance of the issue.

I am going to talk mainly about population and economic migration but, on the way, I should like to flag up briefly the way in which rapid population growth will affect not only this country but the rest of the world through its impact on the environment by accelerating resource depletion and climate change. We are already faced with a time bomb since, although the output of greenhouse gases per head in the developing world is low at present—about one-20th of ours per head—this will inevitably increase with rising standards of living. China is already providing us with an example.

I should declare an interest in that I am a long-standing member of the All-Party Parliamentary Group on Population, Development and Reproductive Health. In January 2007, we published a report, Return of the Population Growth Factor, Its Impact upon the Millennium Development Goals. This was a distillation of a series of parliamentary hearings of experts in the fields of population and demography. Its conclusions, in brief, were that each of the first seven MDGs was adversely affected by population growth when it exceeded the rate of economic development. This applied particularly to sub-Saharan Africa, where population growth rates are the highest in the world and economic development the slowest. With regard to MDG 1, which is to,

“eradicate extreme poverty and hunger”,

the report says on page 21 under the heading “Running to stand still”:

“In sub-Saharan Africa, GDP per capita has been falling at nearly one percent a year, and those living in poverty … rose modestly from 44.6% to 46.4% between 1990 and 2001”.

Annual economic growth is expected to be 1.6 per cent between 2006 and 2015 but,

“due to the countervailing effect of rapid population growth, the World Bank predicts that by 2015, 340 million people in Africa will be living in extreme poverty, compared with 318 million in 2001”—

an increase of 22 million. The pressure to seek a better life in another country comes not so much from overcrowding and population growth per se but from lack of employment and poverty—in other words, “the economy, stupid”. Initially, employment is sought in the rapidly increasing slum cities of the developing world, but when this is not forthcoming the most enterprising citizens seek it elsewhere—perhaps in the El Dorado of the prosperous north and west. As the noble Lord said, the populations of some of those countries are in decline with a shortage of young people, so inward migration may not always be a bad thing.

Of course, there are reasons other than poverty for migration—conflict and political persecution are two. In the past, this country has benefited greatly from migrants from Europe fleeing political persecution. The largest number of immigrants, as the noble Lord pointed out, are seeking their way out of poverty.

There are two approaches to the problem, which are equally important. We must make more efforts to boost the economies of the developing world and diminish poverty. This in itself will result in fertility rates coming down. We all accept that that is a gargantuan task and inevitably slow. In the mean time, much can be done to assist mothers to have fewer children. The two most important are to aim to boost female education and to ensure that contraceptive supplies are made available to the 220 million women who wish to use them but at present cannot obtain them. There is no time to develop these themes. Suffice it to say that DfID is well aware of the needs of the developing world in reproductive health and family planning—not least because our group makes sure that they are aware. DfID devotes a greater proportion of its budget to it than most other countries. I am sure that the noble Baroness in her answer will take the opportunity to describe DfID’s work in this field.

[Baroness Northover]

I remind noble Lords that this is a tight time-limited debate, and when you hit four minutes you have already exceeded your time.