Health and Social Care Bill

Baroness Jay of Paddington Excerpts

Wednesday 16th November 2011 Lords Chamber

[Lord Warner]

I apologise to the House for my enthusiasm to get in to this debate on public health, which I regard as a key part of this Bill. I am extremely supportive of much of the thrust of the Government’s approach. I rise to speak to Amendments 62, 64, 65 and 68, which are in my name and in the name of the noble Lord, Lord Patel—and, in the case of Amendment 62, also in the name of the noble Lord, Lord Walton. Unfortunately, neither of those noble Lords can be with us today. However, I strongly support the remarks made by my noble friend Lord Beecham.

These amendments to Clause 8 are aimed at strengthening the Secretary of State’s duty on the protection of public health. Let me make clear that, as I said, I very much welcome the Government’s emphasis and commitment on public health and support the thrust of their changes. It is time for us to give much more prominence to public health if we are to relieve the pressures on the NHS in the coming years. However, I believe that we could go further than the Government have in terms of the Secretary of State’s duty, as currently expressed; hence these amendments.

Amendment 62 requires the Secretary of State, when taking steps to protect the public from disease or other dangers to health, to do so on the basis of,

“using the best scientific and other evidence available and without regard to special interests”.

The first prong of this amendment is to cement evidence-based policy into the discharging of the Secretary of State’s duty to protect public health, and to make clear the use of science in doing so. All Governments like to claim that their decisions are evidence based—nothing surprising or new in that—but all too often they are not. For example, it has been a very long haul getting all government departments to have chief scientific advisers. Even now, the Treasury has only recently appointed its first chief scientific adviser.

Your Lordships’ Science and Technology Committee, of which I am privileged to be a member, is currently looking at the experience of chief scientific advisers in different departments, and it is very clear that their status and influence vary considerably. In the area of public health, it is absolutely clear that using a strong scientific evidence base, including the social and behavioural sciences, is very important indeed. Nowhere was this more important than in the controversial issue of banning smoking in the workplace and in public places. The dangers of second-hand smoke were discounted until the scientific evidence made that position untenable. If I may say so, we are now seeing a rerun of that debate over the issue of smoking in cars and the danger to children of second-hand smoke. Without going into particular issues, I want to emphasise the importance of Health Secretaries—of all political persuasions—making public health policy and taking decisions on the best scientific evidence available, and of requiring them to do so in statute.

The second prong of Amendment 62 is something of a belt-and-braces approach, requiring the Secretary of State to not be overinfluenced by special interests. There have been long-running concerns about the influence of the tobacco, food and drink industries on successive Governments over public health policy. I am not making a party political point here. All Governments have been subjected to pressures by those particular special interests when they have tried to deal with protecting public health. I will not go over the ground in detail because it is well documented and in the public arena.

However, the issue has been given a new burst of life because of this Government’s attachment to nudging public behaviour in the right direction rather than legislating. Again, the Science and Technology Committee of your Lordships’ House, under the chairmanship in this case of the noble Baroness, Lady Neuberger, produced a report recently on this issue. While the nudge approach can be useful in changing public behaviour, that it is a sufficient remedy in many critical areas, such as obesity, is not supported by good evidence. The result is that powerful interests backed by skilful marketing can still defeat important public policy advances.

Lobbying by powerful special interests is a feature of all western democracies, and a potentially dangerous one in the sphere of public health. We should take the opportunity of this Bill to require future Health Secretaries in this position not only to pursue science-based policies but to resist the blandishments of special interests. Amendment 64 is a simple substitution of “must” for “may” in terms of the steps that the Secretary of State should take in carrying out his duties set out in new Section 2A(2).

Amendment 65 extends the final item of that list of steps, so that services made available assist the public to take,

“responsibility for improving their health and well-being, including access to their own medical records”.

Many of the pressures placed on the NHS result from lifestyle choices that we all make that can damage our health. We need to make it a central tenet of public health policy that we should assist people to take more responsibility for their own health and well-being, rather than simply expecting others to bear the cost of treating them when they become ill. Obesity is a good example. In most cases, the solution lies literally—if I may put it this way—in our own hands. Accessing and probably holding our own medical records would reinforce that personal responsibility. This Government, like the previous one, rightly emphasise personal responsibility alongside rights. In the sphere of public health, Amendment 65 gives a push to that approach. I hope that the Government will accept it in the spirit in which it is proposed.

Finally, Amendment 68 extends Clause 2A(4) to give the Secretary of State a bit more help in carrying out his duties to protect public health. This amendment requires the Secretary of State to appoint an independent standing advisory committee on public health of no more than 15 people to provide advice on a regular basis as well as when the Secretary of State seeks it on a particular issue. The reports of that committee will be available to Parliament and the committee can report to the Secretary of State on any matters of concern that it has about the state of public health. I would envisage this committee being a major focus for the provision of scientific evidence to underpin public policy in this area under Amendment 62. I think that Amendment 68 is self-explanatory and its benefits self-evident in an area as important as public health.

I hope that the Minister will see these amendments as constructive strengthening of the Government’s ambitions on public health and enabling a helpful legacy to be left to the next Health Secretary whenever this current Health Secretary chooses to leave his job. I believe that these amendments go with the grain of the powerful, recent report on public health by the Select Committee, which proposes further strengthening of the Government’s powers. I hope that the Government will be sympathetic to these amendments and to Amendment 95, in the name of the noble Lord, Lord Patel, to which I have added my name.

[Baroness Jay of Paddington]

My Lords, I wonder whether my noble friend could help me with something that seems to be implied in his very eloquent deliberations about the amendments. I agree with him entirely that, in the public health arena, political leadership—the role of Governments of whatever party—is enormously important, particularly, as he said, in resisting the blandishments of external lobbies and so on. Does he see a potential conflict between the additional powers which he is advocating for the Government and the Secretary of State in this area, which I would entirely support, and the decision of the Government to reduce the powers of the Secretary of State in general for health services, healthcare and the promotion of general health matters in the way in which the Committee has discussed at some length on earlier clauses?

[Lord Warner]

My Lords, my noble friend raises a very important point. I can see some differences of approach here. Today, I am speaking on the rather narrow issue of helping the Secretary of State to be a powerful influence in improving public health. Of course, it is for your Lordships' House to debate further, as we progress through the Bill, whether we want Clause 1 to go a little further than the Government seem to want in terms of the Secretary of State’s responsibilities. I have sympathy with my noble friend in seeing a slight confusion on the part of the Government in some of these areas.