Health and Social Care (Re-committed) Bill

Margot James Excerpts

Wednesday 7th September 2011 Commons Chamber

[Rushanara Ali]

Thank you, Madam Deputy Speaker.

Amendment 1169 would be of great benefit in tackling health inequalities. It would make a real difference to people’s lives. Requiring the Secretary of State to lay an annual report before Parliament on progress towards ending health inequalities is therefore key in ensuring that proper accountability continues to exist. What is he afraid of? He could see the impact and put in place mechanisms to continue to improve, learning from the evidence and making progress. Considering how we can reduce inequalities in constituencies such as mine is a constructive way forward. I call on the Secretary of State to think again and accept this sensible amendment.

In conclusion, as the Marmot review stated, the

“link between social conditions and health is not a footnote to the ‘real’ concerns with health…it should become the main focus.”

Tackling health inequalities should be a central aim of health care policy for any Government, and the amendment would be crucial for achieving that. I hope that Members on both sides will back it and that the Secretary of State will take note.

[Margot James (Stourbridge) (Con)]

I want to support the leadership that the Bill ascribes to public health and the role of the patient and empowered individual in taking responsibility for their health care as far as is possible. I congratulate the Government on setting public health free, as I see it, and taking it out of its ivory tower. It has been in the preserve of the primary care trusts and although in some PCTs it is given life, in others it gathers dust and is vulnerable to financial raids from time to time as budget pressures build and people seek to take money from an area where the public do not necessarily see the results for a fairly long time and to give it in preference to things that cause short-term pain. Regardless of which party has been in government, that has always been the case with public health.

If we consider where public health can make a difference in preventing ill health, we can see that the future of the NHS depends on a much better preventive strategy. Perhaps the best thing that the previous Government did in health care policy was the smoking ban, which will probably save more lives in the long run than anything else. We could consider some of the other areas that are ripe for similar treatment. I do not mean that we should ban alcohol, but we could consider public health policy and what it could do to reduce the incidence of sexually transmitted diseases, HIV, alcohol abuse and mental health problems. Many of the issues to do with drugs are about education and prevention, too.

I am pleased to see links being built into other aspects of the Bill. Our proposals for public health in relation to mental health have been strongly welcomed by the Samaritans, because there is so much to do with mental health that takes place in the community. The involvement of local authorities and the leadership role given to them in the Bill should enable aspects of local government policy such as housing, children’s social services and adult and social care to be brought to bear in dealing with these problems.

[Sarah Newton (Truro and Falmouth) (Con)]

Will my hon. Friend give way?

[Margot James]

I would love to but I am aware that others are waiting and I am trying to curtail my comments. [Hon. Members: “Hear, hear!] I will take that as a prompt to get a move on.

I want to address a point that was made earlier about where the director of public health should sit in a local authority. I think it is important that the public health director should report to the chief executive because the public health function will cover so much that is part of children’s services, adult and social care and housing that it is hard to see how they will fit in unless they report at the top level.

In conclusion, I believe that the elevation of public health will enable public health to be placed at the centre of commissioning and that the link between the wellbeing boards and the primary care commissioning groups will enable public health to be instrumental within commissioning. That is where we will see the long-term benefits outrunning the short-term imperatives.

[Alison Seabeck]

I shall cut to the chase because other Members want to speak and many colleagues have spoken powerfully about the benefits of the NHS. I have two very specific questions regarding concerns that people in the south-west have raised with me. These issues relate to part 1 of the Bill, the role of the director of public health, and the making of complaints, as covered by new clause 1. I want to link these issues to the duty of the Secretary of State to ensure that the basis on which actions are taken—indeed, the information that is used—is in the hands of and is accessible to people in the new set-ups who need that information and can use it.

The concerns that have been raised with me relate to the movement of national health service public health staff into local authority control and the fact that the Office for National Statistics currently has a duty to release certain data only to directors of public health, who are part of the NHS. I gather that the ONS has had concerns about this and I am interested to know whether it has waived the requirement for directors of public health to sign a confidentiality and proper use statement every year, or whether it has agreed to the passing of this role into local authorities. I cannot find that in the Bill, although I must admit that I am coming to this a little late—my apologies to colleagues about that—and I would be very grateful if the Minister could tell me whether that issue has been resolved.

Secondly, the Minister will know that we carry out nuclear decommissioning in Plymouth. Is he confident that public health can be fully protected in the way that it has been in the past? I note clause 54 on radiation, but will the Minister look at how H1N1 was dealt with? The first confirmed case of swine flu was in Paignton and the response was carried out by PCT public health staff in Plymouth and Torbay. They worked together rapidly to administer antiviral drugs to nearly 500 pupils and they provided reassurance and support to extremely anxious children and parents. That response was set up within 45 minutes of the initial phone call, despite the fact that it had not been done before, and it was done without any practical help from the Health Protection Agency, which was swamped with other work. The PCT public health staff just got on with it and they did a fantastic job—no other child was infected. Indeed, they compiled a guide on how to do it all, which was passed on and was commended by the Prime Minister. There is a view that such a response will not be possible in a few years’ time, so complaints from the public—this takes us back to new clause 1—will inevitably follow. Clearly, if we get health protection wrong, we can kill people.

In order to avoid complaints on new clause 1, will the Minister say what power the director of public health, sitting within the local authority, will have to galvanise staff across organisations? Will they be the appropriate authority, or will responsibility sit elsewhere? Will they have to go through another senior officer? Who is ultimately responsible if they get it badly wrong—the local authority, the director of public health or the Secretary of State? Or is it another instance when the Government are saying, “Not me, guv” and passing the buck to the local council and the political leadership of that council? If there was a viral outbreak in various parts of the country, widely spread, would the individual local authorities be held responsible for dealing with it, coming up with solutions and coping with the outcomes, or is this a case in which the Secretary of State actually has a clear duty to take the lead?