Public Health

Countess of Mar Excerpts

Tuesday 30th November 2010 Lords Chamber

[The Countess of Mar]

I am awfully sorry to disturb the noble Earl and I am sorry to have to ask two very venerable noble Lords if they would mind having their conversation outside the Chamber as suggested in the Companion to the Standing Orders. I cannot concentrate on what the Minister is saying.

[Earl Howe]

The Statement continues:

“It will also develop health protection plans and screening programmes to protect people from health risks. Because we also know that the foundations of good health are rooted in the community, often at a neighbourhood level, we must strengthen and renew local leadership to ensure that these efforts reach deeply into communities and match their unique circumstances.

Under this White Paper, the lead responsibility for improving health will pass to local government for the first time in 40 years. We intend to give local authorities new powers to plan, co-ordinate and deliver local strategies with the NHS and other partners and to embed the foundations of good health in ways that fit local circumstances. Directors of public health will provide strong and consistent leadership within local councils.

We also intend to establish the new local statutory health and well-being boards as a way of bringing together the NHS and local government. Whereas before, public health budgets were constantly raided by other parts of the NHS, we will prioritise public health spending through a new ring-fenced budget. We will look to the highest standards of evidence and evaluation to ensure that this money is spent wisely. The new outcomes framework for public health, on which we will consult shortly, will provide consistent measures to judge progress on key elements across all parts of the system—nationally and locally. The framework will emphasise the need to reduce health inequalities and will be supported by a new health premium incentivising councils which demonstrate progress in improving outcomes.

We have learnt over the last decade that state interventions alone cannot achieve success. We need a new sense of collective endeavour—a partnership between communities, businesses and individuals, which transforms not only the way we deliver public health, but also the way we think about it.

Through the public health responsibility deal, the Government will work with industry to help people make informed decisions about their diet and lifestyle, to improve the environment for health, and to make healthy choices easier. Through greater use of voluntary and community organisations, we will reach out to families and individuals and develop new ways to target the foundations of good health. Reflecting the framework in the ladder of interventions developed by the Nuffield Council on Bioethics, we will adopt voluntary and less intrusive approaches so that we can make more progress, more quickly and resort to regulation only where we cannot make progress in partnership.

This is a time when the NHS and social care are under intense pressure from an ageing population and higher costs. It is a time when we must therefore put as much emphasis on preventing illness as we do on treating it. In the past, public health has been a fragmented and forgotten branch of the health service. This White Paper will make it a central part of everything we do, and we will bring forward legislation in the new year to enact these changes.

By empowering local authorities, by strengthening our knowledge of what works and by establishing the right incentives to drive better outcomes, the White Paper will deliver the strategy and support needed to reduce health inequalities and to improve the nation’s health. I commend this Statement to the House”.

My Lords, that concludes the Statement.

--- Later in debate ---

[Earl Howe]

My Lords, the noble Baroness asked me a number of questions there. I may not be able to answer all of them now, but I will certainly write on those that I cannot.

As I mentioned earlier, it is important to recognise that in part the status of directors of public health will be confirmed by virtue of not simply being appointed locally, but also by being appointed from the centre by Public Health England. That will confer an added status to them. With the dual accountability that I referred to, primary accountability would be to their employer, the local authority, but the Secretary of State would have a backstop power to dismiss directors of public health on the basis of a failure to discharge local authority responsibilities in the area of health protection. Again, while one does not want to dwell on that power, it signifies that this is a person who will be there very much as the representative of the Secretary of State.

The noble Baroness asked what happens if there is a difference of view. Differences of view will arise but the important point to emphasise here is that we want to see them sorted out at a local level wherever possible. That will not always be possible but it should be the aim that health and well-being boards and consortia should decide, in the light of the joint strategic needs assessment and other factors, what the priorities are locally and how the budget is to be spent. It has to be that way: second-guessing from the centre is bound to lead to perverse consequences. However, there will be mechanisms available to ensure that the NHS commissioning board will have a role in trying to resolve these issues and the noble Baroness will see, when we publish the health and social care Bill, that the Secretary of State will have a backstop power in extremis.

She asked about the health premium. We will be publishing a document for discussion on this. We want to hear the views of everybody as to how this should work. Clearly, if a health premium is paid it has to reflect a measure of genuine progress in reducing health inequalities, while recognising that some areas start off with the handicap of having particularly deprived communities to work with and that the task is thereby more difficult. It is important that the department receives the views of interested parties to see how this is going to work.

On sexual health, we are looking to see what more can be done to increase the awareness of risks, prevent infection and promote access to screening and treatment. The consultation documents, which will be issued shortly, will set out the proposed funding and commissioning routes for public health services, including how comprehensive sexual health services might best be commissioned. I hope the noble Baroness will feed into that.

[The Countess of Mar]

My Lords, the noble Earl mentioned looking at the causes of the causes very early on in his Statement. I think it is now well accepted that a foetus is not protected by either the placenta or the blood-brain barrier from environmental assaults. I am concerned that a lot of the obesity that we see now in young children who run around normally and cannot be described as couch potatoes—although perhaps their diet is deficient—may have originated in the womb from oestrogen-mimicking hormones and by chemicals such as bisphenol A and phthalates. It seems to me that we disregard these factors at our peril and we are blaming people for factors that are beyond their ability to control. Another point is the effect of maternal stress on the foetus. High cortisol levels in the mother affect the child and cause ADHD and educational problems later on in their lives. What is the Minister doing to look at what is happening to babies in the womb and the effects on them in their future life?

[Earl Howe]

I shall need to write to the noble Countess on exactly what work programmes are in train in that area but she is absolutely right—this is an area that I have taken a close interest in over the years. It is fundamental to understanding both health in childhood and later on in adulthood, and behaviour in children.

We fully recognise that good nutritional status is important at all stages of life. That includes the role of the diet in pre-maternal health, and affects teenagers in particular and the elderly, where there are concerns about malnutrition; I know that is not the focus of the noble Countess’s question. The national diet and nutrition survey will allow us to continue monitoring the status of the diet in the UK population and to target interventions where they are needed. I will write to the noble Countess to give her further particulars.