Health and Social Care Bill

Baroness Eccles of Moulton Excerpts

Tuesday 11th October 2011 Lords Chamber

[Baroness Eccles of Moulton]

My Lords, I am delighted to support this Bill. It is a good Bill, which has moved on a lot since it was first presented to the other House in January. The listening exercise in the spring has been described as a sign of weakness by some, but a Government who listen to people’s opinions and are not too fixed in their position to accept improvements is refreshing. Equally, the Future Forum's invaluable work and the changes proposed in its report have put this Bill on a much surer footing. I would particularly like to acknowledge the contribution of the Secretary of State and, of course, my noble friend the Minister for so readily accepting its core recommendations. All will agree that, as long as we end up with a Bill that works for patients, which we must not forget is crucial, the rather choppy ride that it has received through Parliament will be all but forgotten.

This evening I shall focus also on public health. It is such an important subject that I am pleased that, by extraordinary coincidence, the noble Lord, Lord Brooke, has already spoken to us on it and focused your Lordships’ minds on it. Public health is one of the key areas in the Bill and is a topic that we so often forget to talk about.

What do we mean by public health? So often when we hear the term, it evokes memories of the great Victorian public health Acts of 1848 and 1872. They sought to reduce the levels of cholera and dysentery by providing more hygienic waste disposal networks and sanitising water supplies. Those were pressing issues in those days. Today, public health is still faced with many problems. Some of them have been around for a long time, although they change in shape and form as time goes on. Examples, which have already been mentioned by the noble Lord, include poor mental health, alcoholism and substance misuse, although there are many more. One that stands out as a new threat to health is obesity. It is important that these problems are tackled head on through this Bill. I do not know how many of your Lordships listened to the debate introduced in the Chamber last week by the noble Lord, Lord Crisp. Many of your Lordships might know that obesity is a subject on which my noble friend Lord McColl focuses a lot. My noble friend’s speech last Thursday was very much focused on the principle of eating less. He reckons that if people eat less they will not weigh so much.

England’s NHS budget increased from £35 billion in 1997 to £106 billion last year. However, for reasons that it is difficult to understand, there seems to have been little attempt to focus on preventive measures and public health in general. I am repeating a bit what has already been said. The scale of the problem is alarming. Every year 18 per cent of all deaths can be attributed to smoking; there are around 15,000 premature deaths per year in England associated with alcohol misuse; and more than half of all adults are overweight or obese. Poor public health inevitably affects the most vulnerable communities in our society.

We need to have a greater awareness of the importance of prevention. Talk to any public health expert and they will extol the virtues of preventive approaches and early interventions. Preventive public health strategies can include innovative health guidance, talking therapies, effective targeting and community care. All have proven benefits. They are, however, sadly all too often missing from commissioning strategies. Therefore, any effective public health strategy must have persuasion and prevention at its heart. The Bill will have many positive influences in these areas. For example, for too long money that was given to local health trusts and earmarked for public health was seen as a general pool to dip into when times were tight. This is why it is very helpful to see a commitment from the Secretary of State to ring-fence public health funds. At last local areas will have budgets that are safe, secure and will be spent on public health.

At a national level there is a rationale for health protection to rest with central government, as the nature of various threats to health, ranging from infectious disease to terrorist attacks, are not generally amenable to individual or local action and clearly need to be centrally organised. As a result, the disappearance of the Health Protection Agency and the transfer of its responsibilities to the Secretary of State and Public Health England are to be welcomed. More locally, directors of public health will be the linchpin behind the intended public health reforms in the Bill. Giving these directors budgets and providing a democratically accountable leader for improving health in a local area is entirely welcome. Co-ordinating those engaged in public health will also be important.

The NHS Commissioning Board will be commissioning extra health visitors. The clinical commissioning groups will be commissioning certain public health services and will also be working closely with the new health and well-being boards. These organisations will need to work together in an effective way. This will require strong leadership from the directors of public health. To do this, these positions will need to be given the flexibility and independence that will attract strong candidates. It is not yet quite clear that, as they currently stand, they are seen in this light. Are they the interesting, important roles that give the opportunity for outstanding candidates to make a real difference, or will they give directors the responsibility for changes that they will not have the authority to achieve? My noble friend the Minister will want to look at this area very closely in Committee.

There is much to support in the Bill. It is said that we do not need the many changes—that in times of austerity too much is at risk. However, the problems we face are too serious for inaction. I hope that this Bill will initiate a sea change in the way that we approach the nation’s health and be a worthy successor to the public health Acts of long ago.

I will not be supporting the amendments of the noble Lords, Lord Rea and Lord Owen. It would not be right for the health service to be kept waiting any longer for the Bill by delaying the Bill’s passage through the House.