Health and Social Care Bill
Lord Rooker Excerpts(12 years, 6 months ago)
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Lord Rooker
“( ) The Secretary of State shall appoint a Chief Environmental Health Officer for England.
( ) The Chief Environmental Health Officer for England shall give advice to and report to the Chief Medical Officer for England on all such aspects of environmental and public health as are relevant to the public health functions referred to in this section and the duties referred to in section 2B of this Act.
( ) The Secretary of State shall report to Parliament annually on the work of the Chief Environmental Health Officer for England.”
Lord Rooker
My Lords, this is a brief probing amendment that is mirrored by my noble friend’s Amendment 75A, which is identical. I originally thought that I had tabled this as a new clause and it had appeared as an amendment. I would like to take the opportunity, by the way, to apologise to the House for being missing when a couple of the amendments that are in my name were moved by other noble Lords. My absence was unavoidable.
The reason for the amendment is straightforward: it is to test the views on the creation of a chief environmental health officer for England. Historically, of course, there has been a chief environmental health officer position since the days before 1974, when I was elected to the other place. It was abolished, I think, on 1 April 1974 during the massive reorganisation that year. That was the last time local authorities had the lead responsibility for public health services. Each local authority had a medical officer of health in those days—in Birmingham, in fact, we called them the chief medical officer of health.
Today, England has a Chief Medical Officer of health, but not a chief environmental health officer. The amendment, and my noble friend’s new clause, proposes that the Secretary of State should appoint a chief environmental health officer for England. In Wales, there is a chief environmental health officer in post. In Scotland and Northern Ireland, there are arrangements that are similar to that. Indeed, there are things happening in the devolveds that are streets ahead of what is happening in England. I have to say that my experience is that Westminster, in the centre, is completely unaware of it all, mainly because, regretfully, there is not a degree of communication. The respect agenda is not actually being played out in practice. Nevertheless, these things are happening elsewhere and there is a good case for making similar arrangements in England. This would recognise the role played by environmental health in promoting health and well-being and the importance of assuring environmental health input into policy-making at the highest level. That is part of the key issue: to get it involved at the highest level.
There are some other amendments, for a further debate, that relate to the complications—again, unique in England—of two-tier local government. This issue does not arise in Wales, Scotland and Northern Ireland. There is a complete mishmash in England. The way in which we inherited the current two-tier local government structure was not planned. That actually highlights some of the difficulties with environmental health, which cannot be done and is not done at county level, of course, although I will save that point for other amendments.
England currently lacks this input into policy-making at the highest level. The appointment of a chief environmental health officer would assist in that area. I am very guided in this by the Chartered Institute of Environmental Health. It has made some very positive remarks about the Bill and given some input into this part of the Bill, in no way to whinge or criticise but rather to strengthen the Bill.
It is envisaged that the chief environmental health officer will focus on a preventive approach to achieving good health outcomes, and in particular on the wider determinants of good health and well-being. The postholder will be able to review the relevant data and advise the Department of Health, Public Health England, NICE and the Chief Medical Officer. It is envisaged as part of the package of proposals and amendments that the chartered institute has proposed that the chief environmental health officer answers to the Chief Medical Officer to have that input into preventive strategies and the wider determinants of health, in the widest sense that the public understand it, and to oversee the development of good practice within local authorities and their partner organisations.
Baroness Northover
My Lords, I thank the noble Lord, Lord Rooker, for giving me the opportunity to highlight the outstanding work that environmental health officers carry out in district councils as well as in the private and voluntary sectors. The Chartered Institute of Environmental Health, to which he referred, also does an excellent job in presenting the issues nationally and in liaising with central government. They will all continue to play a crucial and developing role in public health.
The noble Lord has long been a doughty fighter on environmental issues. I remember my astonishment when, as a Minister, he granted an amendment which I had tabled that he had been refused permission to grant. I therefore feel very mean in suggesting that I will not be reciprocating today. However, when the noble Baroness, Lady Finlay, raised her points, I was rather glad that, when acting on the Energy Bill in relation to the point for which she fought on preventing carbon monoxide poisoning, I was at least able to grant something there, although I know that that was more limited than what is being sought now.
I should stress that environmental health officers, along with other local authority staff, will be very much inside the group of professionals and practitioners in local government who will form part of the wider public health workforce. Consequently, we expect many opportunities for them in the future to contribute to and to shape local plans and priorities. Surely that will help transform this area, because public health, as I indicated, needs to be defined widely. In its new location it will change in order to have the effects that we wish to see. The noble Lords, Lord Beecham and Lord Rea, are right to urge working together, especially given the history of these officers.
At the national level, the Chief Medical Officer will have a central role in providing impartial and objective advice on public health to the Secretary of State for Health and to the Government as a whole. She will be the leading advocate for public health within, across and beyond the Government, advocating the design of policies that improve health and well-being. We are clear that this role includes advising on environmental health issues as well, and that the Chief Medical Officer will in turn continue to be able to seek such advice on environmental health and other issues whenever necessary just as she can do now. The Government believe that, as valuable as environmental health expertise is, this makes the post of chief environmental health officer unnecessary.
The noble Lord is of course right to urge discussion across devolved areas in all fields, as we can learn from each other. He might be reassured that the Chief Medical Officers of the various Administrations meet regularly, and that Public Health England, like the Health Protection Agency, will in some ways have a remit that extends beyond England and thus offer the chance to learn from the experience of others. We remain confident that Ministers will receive high-quality advice from the CMO on environmental health. I stress that we also need to look internationally and draw on research and experience very widely in this field. We can learn a lot from that.
The noble Lord’s amendment calls for the Secretary of State to,
“report to Parliament annually on the work of the Chief Environmental Health Officer”.
We agree on the need for transparency and believe that the Secretary of State’s accountability for public health at the national level is a major strength of the new system. This is why Clause 50 of this Bill requires the Secretary of State to publish an annual report to Parliament on the working of the comprehensive health service as a whole, which will include his and local authorities’ new public health functions.
The noble Lord, Lord Whitty, asked what the Government are going to do about ring-fencing the budget. Some of the issues that he raised were discussed in the first grouping on public health. I do not know whether he was in his place at the time. If he was not, he should be reassured that his noble friend Lord Warner intends to flag up some of the concerns that he raised in a later grouping, and we have various other groupings in which his concerns will no doubt be flagged up. I point out in relation to our discussion on the previous group that we will be using regulations to set out what essential services local authorities have to provide. Noble Lords can also see what is in the White Paper.
I want to clarify what will be covered in regulations so that if I was not clear in the last grouping, I can be clear now. Essential services that we think need to be delivered consistently across the country—for example, dealing with local emergencies—will be included in regulations. We will use publications like the updated White Paper, which I quoted earlier, to set expectations about the totality of services to be covered by the public health ring-fence. I hope that that provides clarification.
My noble friend Lord Greaves talked about the co-operation between different councils—county councils, district councils and so on. District councils have local insight and expertise. In many cases they will have the lead on key services affecting health and well-being, such as housing and environmental health. Health and well-being boards will play a big part in local health improvement activity and must find themselves able to involve local councils so that they work most effectively.
The noble Lord, Lord Northbourne—sorry to startle the noble Lord—wondered what would happen if local authorities do not carry out their duties. The Secretary of State does not have a conventional performance management role with local government—I am sure that those in local government will be pleased to know. However, he does have the power to intervene and ensure that particular services are provided if a local authority fails to do so. Local authorities will also have to account for their use of their ring-fenced grants, and the power exists to recoup money if the conditions attached to the grant are not met. I hope that that reassures the noble Lord.
In summary, it is very clear that environmental health is and will continue to be a very important component of the public health system, which will be led locally by directors of public health. I hope that the noble Lord is prepared to withdraw his amendment.
Lord Rooker
My Lords, I am grateful to the Minister for her reply, and particularly for reminding me about the favour that I did her. It proves that Ministers can make policy at the Dispatch Box. I accepted her amendment against advice; I used the excuse that there would have been a government defeat if I had not. She cannot use that tonight because I shall not press the amendment anyway, but I am very grateful that she remembered that.
I do not want to make a long speech. The Minister said that the work of environmental health officers is absolutely fundamental. They are the unsung heroes of policing a system in this country for our citizens on a whole range of issues, whether food, air quality or other matters. The public are aware of them only when things go wrong. I am reluctant to go down this route, but I declare an interest of chairing the board of the Food Standards Agency, which is a government department, and that is why I do not speak on it in this House. Environmental officers are unsung heroes and they deserve our support. They provide a 24/7 operation and they go into areas where, by and large, police officers would go in only pairs. Late at night they visit takeaway enterprises and so on. They do an enormous amount of work.
I also hear what the Minister said in answer to the point about discussion between the four Governments in the UK. If the only link between the four UK Governments on the respect agenda is between the four Chief Medical Officers, we are in dead trouble. Although that is important, it is more important that Ministers in the four Governments who have similar responsibilities talk to each other. Devolution means that things will be done differently—we are not looking for a one-size-fits-all situation—but it is crucial that there is co-operation, consultation and information. Major changes take place without any contact whatever with other Governments and it is the same in this area. There is no doubt that that causes problems. I am sure that we will turn in more detail to the issues relating to local government in regard to other amendments and we may or may not come back to this on Report. In the mean time, I beg leave to withdraw the amendment.
Lord Rooker
“( ) promoting co-operation between each of the authority’s relevant partners”
Lord Rooker
My Lords, I return briefly to the point that I made as an aside on an earlier amendment regarding the effect of local government. As this clause is drafted, it is absolutely clear that not all local authorities in England are public health authorities. It is quite clear that in the areas in England with two-tier local government, the powers and duties apply to the county councils and not the district councils. The county councils are in the same position as unitary authorities: they will be under the new statutory duty to improve the health of people living in their area; they will receive the new ring-fenced public health grant; they will be eligible to earn the new health premium; they will jointly appoint, with Public Health England, the director of public health; they will provide a place in each organisation for the director of public health; and they will operate the new health and well-being board. However, where the county councils differ from unitary authorities is that they do not have the environmental health workforce. That is with the district councils.
This significant difference to the backbone of the public health workforce, which is directly controlled by local authorities, comes from the environmental health cadre. In England, there are 27 shire counties and 201 shire districts within those counties. There are 56 unitary authorities, 36 metropolitan districts, and 33 London boroughs, which of course includes the City of London. This amendment proposes that the Secretary of State and the public health authority shall promote co-operation between each of the authority’s relevant public health partners, which are listed in Amendment 75.
The department is relying on localism. When I was in the other place, one of my boasts, rather than apologies, was that I was never a local government councillor. I love local government. It is independent and it makes a massive contribution to local democracy. But to be honest, I have never put it on an altar as a service deliverer or as a bastion of democracy. Localism, as defined and discussed, and some key issues such as public health and food safety do not go together. I have had agreement to this, even from LACORS. You are relying too much for public protection on the vagaries of all the pressures on local government. Localism and some of these issues do not go together. It is no good kidding ourselves that they will, because they will not. The noble Lord, Lord Ramsbotham, touched on that point and I am glad to reinforce it.
The department is relying on localism to argue that the county and district councils will work together to make the appropriate arrangements for the delivery of public health services. Of course, it is right; there should be flexibility. Not all the areas of England are the same. There has to be co-operation. I repeat what I said earlier on: one size does not fit all. However, a statutory duty to co-operate does not dictate that councils should design their services—it just ensures that they co-operate in doing so. It is not always the case that different levels of local government are willing to co-operate. I have to say, regretfully, that it can sometimes depend on the personalities of the political leaders of the councils. People’s services should not depend on the personalities of the individuals in charge.
There is no option available to local authorities not to co-operate with each other under this amendment. They have to work together to ensure this—but really they should be forced to co-operate. It must be in the Bill to protect those areas where personalities may intervene. The amendment is not limited to the relationship between county and district councils. It requires the public health authorities to co-operate with all the relevant public health partners, which are listed. That helps to embed the department’s requirement that local authorities should develop integrated services with other partners such as adult social services and voluntary and not-for-profit organisations.
There are precedents in recent legislation for such a duty to co-operate. I have been advised, which I freely admit, by the Chartered Institute for Environmental Health. For example, in the case of safeguarding children, the relevant partners are required to co-operate with the children’s services. Again, in the civil contingencies legislation, category 1 responders are duty bound to co-operate with and support all other category 1 responders.
This issue will not be dealt with today but we need to know the Government’s view in respect of this lacuna, almost, of treating England as though it is all a happy band of brothers and sisters and as though everyone gets on with each other in local government. Unfortunately, the two-tier mix is not planned. If England had a two-tier mix by design we might be able to have a better system, but it does not. It is almost an accident. My view is that it should be single tier, which I have probably implied. In Wales and Scotland in particular, the benefit of single-tier local government is clear for those Administrations. One way or another, Ministers will have to address this problem because it will not go away. I beg to move.
Baroness Northover
I am reassured that she is slightly clarified. This has been yet another important exploration of how the new arrangements might work. I realise that there will no doubt be further discussion; nevertheless, I hope that in the light of what I have said the noble Lord will be prepared to withdraw his amendment.
Lord Rooker
My Lords, I am grateful to the Minister and for the support for the fact that we need to address this issue. I am not asking for any more reassurances but I should like to believe that between now and Report there will be deeper discussions with local government, probably even addressing the machinery of government.
I cannot believe that the existing silos of Whitehall will work when the Bill is implemented. There is now a cross-over between health and local government which has not existed in this country for many decades. Therefore, there is going to be a cross-over and a different kind of working relationship between the Department for Communities and Local Government and the Department of Health. That seems to me eminently sensible for reasons of both accountability and delivering a seamless service to the public. After all, that is what it is about. The public do not care where the service comes from; they want to know that the service is there.
I appreciate the constraints that the noble Baroness is under, but I think that it was well worth while giving this issue a run-out. I have no doubt that we will return to it on Report, but basically I hope that there is more of an impetus and that Ministers’ officials will say, “Well, we do need to have a little bit more discussion to lock this thing down”. The Government cannot afford to get this wrong with this legislation, as the Minister has realised. I think that, with a bit of extra thought, consultation and discussion within government and with local government, a satisfactory solution can probably be found. I beg leave to withdraw the amendment.