Health and Social Care Bill

Lord Warner Excerpts

Wednesday 29th February 2012 Lords Chamber

[Lord Patel]

My Lords, I wish to speak to the amendment in the name of the noble Baroness, Lady Cumberlege. Of course, the amendment of the noble Lord, Lord Beecham, is attractive. It would give Public Health England independence as a special health authority. However, the Government are obviously not ready to accept that, otherwise why would they have abolished the HPA? We would be recreating the HPA if it were a special health authority.

However, I commend the Government on giving public health a high profile, indicating that they want Public Health England to be closely associated with, and be accountable to, the Secretary of State. Public Health England needs to be a body that is nationally and internationally recognised for the authoritative work that it does, as the HPA does now, for the advice that it can give and for attracting high-profile public health specialists. For that, it needs high-calibre leadership. An executive agency that does not have an independent chair or non-executives who will support a high-calibre chief executive will not be recognised or gain people’s confidence.

I have wondered where the model comes from and I think that I now know. I wonder whether the Secretary of State has made a trip to Atlanta, because the model is exactly like that of the CDC. The Centers for Disease Control is a federal executive agency. It has a board but it does not call itself that; it calls itself a committee of advisers. It has a high-profile chairman, and the other non-executives are also high profile. However, it is an independent body. It is able to give policy advice and is not restricted in doing so. However, that model does not quite fit in for England because, apart from being different, our system is different when it comes to having an independent chair with non-executives. Its function is advisory because it belongs to an executive agency and not a special health authority; otherwise its function would be different. That does not preclude Public Health England from having an independent chair, and I should like to hear why the department thinks that it does. I do not see that the accountability changes at all. Public Health England, being an executive agency, will still be accountable to the Secretary of State. In fact, that would strengthen it.

I agree with the noble Lord, Lord Beecham, that executive agencies are constitutionally part of their parent body, and those employed within them are governed by the Civil Service code of conduct. This includes rules and restrictions on what they may say in public, including before Select Committees, about government policy. I think that an independent chair helps to mitigate this. Because of the critical role that Public Health England will have, this will be important. If it is to be an executive agency, it is vital, for the sake of public trust and confidence, that the Government ensure that the arrangements for the new body provide it with a sufficient guarantee of its independence. Only through being perceived to be independent of government will Public Health England establish a reputation for independent, evidence-based and, above all, trusted expertise.

The model of a single independent organisation employing a large number of public health specialists is an attractive one—one which has worked to great effect, as in the case of the Health Protection Agency. We have an agency that is partly independent: the MHRA. The MHRA has an independent chair, it is accountable to the Secretary of State and it gives policy advice. Perhaps the mechanisms for delivering that policy are different, so that it can be managed without breaking any rules. I do not agree that there are EU rules that forbid it to bid for external funds. I would like to hear which EU rules those are. There are mechanisms for getting external funds through a different arrangement, but that does not forbid it to access external funds.

The HPA has built up an international reputation. Its expertise in carrying out contract research is such that it attracts half its current budget from external funding. Are we going to allow a system based on somebody’s whim to end all that? If we are, we will have to ask ourselves a question. Do we want a structure that seems closer to the Civil Service and to politicians but that weakens an internationally recognised body which is powerful and able to deliver the high-profile agenda which the Government have set for Public Health England? We need to examine that. I feel that there is room for discussion so we can arrive at a compromise solution that will achieve all this.

The amendment addresses other issues to which the noble Baroness has already referred, including independent research, published researched findings et cetera, all of which should be possible for Public Health England, as an agency of the department, to accomplish. I hope that the Ministers and the noble Baroness will consider these suggestions. Let us give this serious thought. Let us not reject it out of hand simply because, at half past 10 at night, we do not have time.

[Lord Warner]

My Lords, I rise because I have added my name to the amendment of the noble Baroness, Lady Cumberlege. I did so because there is a part of me which actually wants to save the Health Secretary from himself. He is going down a path—for good reasons, in some ways—by which he wants to be accountable, through the department, for public health in this country. I understand that, and I understand some of the arguments that the Government have put forward about ministerial responsibility and accountability which were at the heart of some of the thinking behind the Public Bodies Bill. I can understand why that will happen. However, this is an area where science is of the essence. The Secretary of State and the Department of Health’s management and credibility in public health would be seriously damaged if the scientific underpinning of it were not sound.

The CDC in America—and I have been to the CDC in my visits to America—is an executive agency but it is a very special executive agency. It has a route into Congress to secure its funding. That makes it very different from executive agencies in this country. It has that route into Congress because it has a very strong scientific reputation. It is the credibility of its scientific reputation that enables it to be both independent and a part of the federal Government.

We cannot create that quite as easily with an executive agency here. I believe that the Government made a mistake, almost in a casual way, by abolishing the Health Protection Agency without being sure that they had another model to put in its place that would preserve that scientific independence and the kind of funding that the HPA was able to raise. We do not live in such splendid financial circumstances that we can casually toss away £150 million a year—which is the danger that we are in. I have not yet heard assurances from the Government about how they will protect access to that funding, and how they will protect the ability of people working in Public Health England to undertake independent research and be sure that their findings will be published without being censored in any way. We need absolute guarantees on that, and they should be in the Bill. That is why the amendment of the noble Baroness, Lady Cumberlege, is so convincing. I would prefer to have a special health authority, if we thought we could get one. We have compromised by going for an executive agency. However, the agency must have the kind of dimensions that are set out in Amendment 162.

I will say a few words about the issue of the chair. I heard the story that the noble Baroness, Lady Cumberlege, mentioned—namely, that the Secretary of State would be interested in the Chief Medical Officer being the chair of the committee overseeing the work of Public Health England. I am a member of the Science and Technology Committee. In two inquiries we came up against the issue that in the Department of Health, uniquely across Whitehall, we have a Chief Medical Officer who is also the Chief Scientific Adviser to the Government. Both jobs seem capable of keeping someone gainfully and happily occupied full-time for most weeks of most years. Adding the chairmanship of Public Health England would be an incredible proposition. There are already concerns in the Science and Technology Committee about combining the posts of CMO and Chief Scientific Adviser. There is an unresolved issue about how we will proceed on that. However talented Dame Sally Davies is, we do not want to muddy the waters further by asking her to take on the chairmanship of Public Health England.

We need to get to the bottom of the guarantees that are required to preserve the integrity, scientific independence and public credibility of Public Health England. If we are to have an executive agency, we need something very like what is proposed in the amendment of the noble Baroness, Lady Cumberlege. I hope that the Government will accept it and give us some certainty that the money that the HPA has raised in the past will be guaranteed as something that the new executive agency, Public Health England, will also be able to secure.

[Baroness Jolly]

My Lords, I will speak very briefly, because a lot has been said on this amendment, to which I was happy to add my name. I welcomed the amendment and the structure that it laid out. I am sure that my noble friend Lady Cumberlege will address the amendments to the amendment.

The issue is one of culture. The culture proposed by the Government does not achieve the desired vision for Public Health England. An executive agency is proposed that will be independent, able to speak out without check and research as it thinks necessary, with an independent chair and non-executive directors. At the beginning of Committee, I met the president of the Faculty of Public Health. In advance of this debate, I rang her this week and we spoke again. She expressed her anxiety about the structure proposed by the Bill.

The role of Public Health England should be to implement the policy made by the department. It should also have the opportunity to influence that policy. Clearly, the Government’s structure does not allow for that. I would really welcome an explanation from my noble friend about the rationale for favouring an organisation that is lacking in independence and that therefore will also lack in public and professional trust.

--- Later in debate ---

[Baroness Northover]

As I have outlined, there is independence. It is key to the changes that we hope to put in place in terms of public health that it moves to the centre stage and that the Secretary of State has a much more direct line of sight in terms of promoting public health and the protection of the public. The Secretary of State will lead and have direct accountability for public health, which many people have welcomed.

Inserting an independent chair and board between him and the individual charge for the day-to-day running of Public Health England could blur those clear lines of accountability and undermine the chief executive without enhancing the agency’s flexibility, responsiveness and effectiveness in dealing with threats. This is not to say that the chief executive should not face independent challenge from the board. On the contrary, the board will include at least four independent—

[Lord Warner]

My Lords—

[Baroness Northover]

This is the Report stage so I hope that the noble Lord has a simple question for clarification.

[Lord Warner]

My query is a point of fact. The Minister is putting great emphasis on the role of the chief executive. Could she tell the House whether the chief executive has a scientific background which is relevant to public health?

[Baroness Northover]

Since the chief executive has not been appointed yet, I cannot give the noble Lord an answer. Perhaps I might be able to continue, especially as it is almost 10.30.

As I have said, the board will include at least four independent non-executive members of the highest calibre, bringing experience of public health, local government, the voluntary sector and business. The challenge they provide will be real and impossible to ignore. Public Health England will also have scientific committees set up to provide rigorous and impartial advice. Executive agencies are normally established administratively, without legislation, and that remains our intention in this case. I realise that my noble friend Lady Cumberlege may want to fix Public Health England’s status in legislation to protect it from undue interference. Of course this is a valid objective, but I hope she will accept that the openness with which Public Health England will operate, and the nature of the Secretary of State’s duty to protect health, would deter him from clipping Public Health England’s wings. He would simply be limiting his own ability to fulfil his statutory duties. I also hope that my noble friend will consider whether the model that her amendment suggests is really in the best interests of public health. A significant advantage of the agency option is its flexibility, allowing Public Health England to adapt and stay fit for purpose without amending primary legislation.

The second part of the amendment focuses on research, to which a number of noble Lords have referred. We recognise the value of the research that the Health Protection Agency undertakes now, and the importance of it continuing. The Bill as drafted provides for the Secretary of State to conduct and commission research and Public Health England will exercise those powers. Noble Lords have expressed concern over Public Health England’s ability to secure health protection research funding. We are satisfied that there is no point of principle preventing Public Health England applying for health protection research funding from external national and international partners, including charities and income generation from commercial contracts. I hope that I can reassure the noble Lord, Lord Patel, that Public Health England can also bid for EU funding, subject to Treasury rules. I hope also that I can reassure other noble Lords that there is no reason why these changes should jeopardise the outstanding reputation that the HPA has had in research.

More specifically, I am happy to be able to confirm that funding from the National Institute for Health Research for research into health protection will continue at its current level and that this autumn we will launch a NIHR research call to be awarded to Public Health England and academic institutions in partnership. Publishing public health research will be not only possible under the Bill as drafted but critical, as noble Lords have indicated, in ensuring that the public health community as a whole learns and progresses. It is also worth mentioning that we expect Public Health England’s published data to be subject to the relevant code of practice on official statistics, which imposes strict limits on Ministers’ access to certain information before it is released.

I am afraid that the amendments tabled by the noble Lord, Lord Beecham, while seeking to enhance Public Health England’s independence, would blur the lines of accountability still further. Executive agency status, we believe, provides by far the most appropriate blend of operational independence and clear accountability. When we debated the special health authority model during the Committee stage, I did indeed, as the noble Lord said, refer to its impracticality. Special health authorities are established to exercise functions in relation to the health service in England, whereas Public Health England needs to exercise functions, such as radiological protection functions, in respect of Scotland, Wales and Northern Ireland. I should also point out that the NHS Commissioning Board will not, in the future, be a special health authority.