Health Promotion Bill [HL]

Lord Lansley Excerpts

2nd reading
Friday 2nd December 2022 Lords Chamber

[Lord Lansley (Con)]

My Lords, I am glad to follow the noble Lord and to welcome his Bill, not only because I agree with its content but because it affords us an important opportunity to discuss how we might improve public health through not only legislation but local, voluntary and community action. I declare an interest: I have a long-standing relationship with ukactive. In that context, I mention the recently retired chair of ukactive, our own noble Baroness, Lady Grey-Thompson, who participated in the debates about a national plan for sport and recreation to which the noble Lord referred. I thoroughly endorse what that committee had to say and the purposes of his Bill.

I will go a bit wider in the public health context and talk about the structure of support for the promotion of public health in this country. Noble Lords will recall that I was responsible for health in the coalition Government for two and a half years. We published the Healthy Lives, Healthy People White Paper in December 2010—exactly 12 years ago—and if anyone wants to see my prescription for public health, they still only have to look at that. It followed and reflected Sir Michael Marmot’s ground-breaking work on the social determinants of health and a “life course framework” for working on public health issues.

The Government have recently talked about the importance of preventive work through the NHS, which I thoroughly endorse. But, although preventive services are a key priority for the NHS, they are not a substitute for a government-wide and societal focus on improving public health. Inequality, poor housing, environmental quality—we discussed this on Third Reading of the clean air Bill—and, not least, economic disadvantage are the major social determinants of health. They require Governments to provide leadership, resources and structures to help us improve public health across society.

This was the originating purpose of Public Health England, which pursued both this agenda and the complementary tasks of combating the key risks associated with poor mental health: tobacco and smoking; obesity, both in terms of diet and activity; air quality; drug misuse; and sexual health. The then Government brought forward plans to address each of those causes of poor health. For example, my noble friend will, I hope, tell us that a tobacco control plan renewal will not be far off.

This was not done at the expense of the health security functions, in respect of which UK expertise was, and is, internationally recognised. For example, in the year following the White Paper, the pandemic flu preparedness plan was published. However, within two years of its establishment, Public Health England’s capacity to meet its responsibilities was progressively limited because of budget cuts and staffing limits. From 2015 onwards, local government’s public health grant was cut by £200 million, and Public Health England saw a 40% reduction in its real-terms funding, reducing its capacity by a quarter.

The classification of Public Health England as not part of the NHS was wrong at the time and a mistake in public policy terms, and in the pandemic we paid for the results of that mistake in lives and many billions of pounds. Public health policies should seek to address both communicable and non-communicable diseases. The pandemic demonstrated, not least in this country, the interaction between vulnerabilities to infection and the effects of chronic disease in the population, often as a result of smoking, poor diet or inactivity.

The resulting division of Public Health England into two organisations is therefore a mistake. The perceived reduction in the independence of the Office for Health Improvement and Disparities, compared with Public Health England—although both are in fact executive agencies directly accountable to the Secretary of State—is also a mistake and risks undermining future responses to public health challenges, not least by failing to engage and mobilise local government. During the pandemic, we saw how important this was and what might have been, had the Government engaged it more fully at an early stage.

The scapegoating of Public Health England, which in reality resulted from a lack of investment in it, should be called out in the coming public inquiry. Public health should, like tackling climate change, be a priority across government, with leadership from the top and dedicated funding. I believe that Public Health England was the right structural approach, as was the transferring of public health responsibilities to local government. We lose tens of thousands of lives prematurely every year because of smoking, alcohol abuse, poor diet and inactivity. During the pandemic, deaths in all of the older age groups were much exacerbated by obesity and diabetes.

So improving our public health, including by enhancing our environments, reducing inequalities, increasing physical activity and reducing average calorie intake—with less alcohol abuse and drug misuse, and stopping smoking—would be central to our future health security every bit as much as the investment in surveillance and the response to infectious diseases. There is a case not only for the changes proposed in the Bill, but to go further and reintegrate the public health function in an agency that leads for this purpose both across government and in society.