Local Authorities (Public Health Functions and Entry to Premises by Local Healthwatch Representatives) Regulations 2012

Lord Collins of Highbury Excerpts

Thursday 7th February 2013 Grand Committee

was completed. The implication is that public health regulation is not a priority, particularly where it concerns individuals other than medics in delivering those services. There is an increasing number of individuals and organisations offering health-related services who are not regulated, trained or accountable, and that is clearly unacceptable. Regulation will provide a crucial mechanism for identifying problems at an early stage and providing opportunities for these to be addressed. The public have a right to be assured that, if things go wrong, there will be accountability, sanctions and procedures to prevent future mistakes. Can the Minister provide reassurance that the statutory regulation of public health specialists from backgrounds other than medicine and dentistry will be in place by the end of 2014, which seems a reasonable timescale? When will work actually commence on the necessary processes for ensuring the implementation of this statutory regulation?

[Lord Collins of Highbury]

I express my thanks to the noble Lord, Lord Willis, for his comprehensive contribution this afternoon. He has covered quite a lot of the questions that I would have asked and there is no point in repeating them. However, I should like to pick up some specific points.

First, in relation to sexual health, like the noble Lord, Lord Willis, we welcome these regulations, particularly the very important principle of the maintenance of open access. HIV has never respected local authority boundaries, nor have other sexually transmitted infections. I have spoken in the Chamber of my concerns about how the new system of commissioning and fragmentation can put at risk regional and sub-regional co-ordination of HIV prevention work. This morning, I visited Positive East, a community facility based in the East End, which does excellent work in a number of boroughs in the east of London. It also participates in outreach and preventive programmes across London and it remains particularly concerned about the future. I appreciate that, while HIV Prevention England is commissioned by Public Health England to run a national HIV programme and local authorities will commission local HIV prevention and testing services, there remains a gap in regional co-ordination. This was highlighted in a health Question in the other place on 15 January, when the Minister assured Members of Parliament that this regional work would continue, but the detail on whether there would be national leadership remains unclear.

What steps will the Government take to encourage co-ordination of sexual health services across boroughs and localities? For example—this was raised by the noble Lord, Lord Willis—25% of HIV prevalence in the UK is in London, which previously had an integrated pan-London programme for HIV prevention. What measures have been put in place, as the noble Lord has already said, to facilitate cross-charging between sexual health clinics for out-of-area residents?

An issue which arises from these regulations is the concern that has been expressed about the pressure on budgets and, certainly, consistency across the country. I am acutely aware that, come the local elections, there will be not so much prioritising of these important issues. This could be a concern. I do not think that sexually transmitted infections have been the highlight of many party manifestos, but they are important issues in public health.

There is no mention in the regulations about the quality of open access health services and the minimum expectation that the Government have of locally commissioned sexual health services. The Minister has repeatedly said that the answer lies in localism—in local circumstances—and that these issues are best addressed locally. However, there is a requirement to ensure that there is proper maintenance of standards on these issues.

Will there be any obligations or duties on local authorities to promote HIV prevention? Currently there are no known incentives on prevention, only on tackling late diagnosis, in the new public health outcome framework.

The other issue which I am particularly concerned about and which I have raised in the House is the question of HIV testing. This is highly fragmented under the new NHS arrangements. I have asked the noble Earl before, and I repeat: how will the Government ensure that HIV testing recommendations from NICE and the British HIV Association are consistently implemented across the country? In some areas of high prevalence it is recommended by NICE that HIV testing should be routinely offered in primary care settings. Will this be implemented? How will this work be funded and provided?

The noble Lord, Lord Willis, also touched on the issue of the treatment of people living with HIV and the treatment of other sexually transmitted infections they may have. I am not sure how that will be covered.

I am also concerned about the question of offering services and treatment through self-management, if you like, for people living with HIV. That is one of the key things I saw at Positive East today. This is not only about the supply of drugs and treatment but about employment advice, general housing conditions and other issues that we have already covered in debates in the Chamber. The funding and support of those activities concerns me. Where is it going to fall? Who is going to take responsibility? Fragmentation is a real worry.

I shall not cover specific local government issues around public health because the noble Lord, Lord Willis, has covered them excellently. However, I wish to pick up on some of the points that the Minister raised in relation to local Healthwatch and its access. We had a major debate on Healthwatch this week, which preceded the Statement on the Francis report on Mid-Staffs. Given the measures outlined in these regulations, will the department review them in the light of the recommendations made by Francis? Issues were raised by Francis which, I suspect, are not adequately covered by the regulations, particularly with regard to access.