Health and Social Care Bill

Memorandum submitted by the Chartered Institute of Environmental Health (HS 09)


1. The CIEH limits its comments to the Bill’s provisions relating to public health. The CIEH welcomes the step-change in addressing public health challenges, including the adoption of the Marmot Review agenda towards tackling the wider determinants of poor health and reducing health inequalities.

2. It is right to give the lead responsibility for public health in England to local authorities. The CIEH believes that the Bill fails to address adequately the complexities of delivering public health services in parts of England where there is two-tier local government. The CIEH proposes a statutory duty to co-operate and agreements for shared services to enable local authorities to make arrangements for the delivery of public health services in these areas.

3. The CIEH welcomes the strengthened duties on the Secretary of State and local authorities to improve the health and wellbeing of the population. To strengthen the support for the carrying out of these duties, the CIEH proposes the creation of the post of Chief Environmental Health Officer for England and an advisory committee.

4. The CIEH foresees that the Chief Environmental Health Officer for England, working to the CMO, will advise the Secretary of State, Public Health England, Parliament and the public on all matters relating to environmental health that have a bearing on public health and wellbeing.

5. The CIEH foresees that the advisory committee will oversee the work of Public Health England and ensure that the experience and views of public health practitioners and members of the public inform the decisions and work of Public Health England.

6. Environmental Health Practitioners work in all communities and all sectors of the economy and their work already supports the public health agenda. The CIEH strongly believes that a greater focus on improving health and wellbeing and reducing health inequalities will be assisted by involving Environmental Health Practitioners in all aspects of such work.

The CIEH’s evidence

7. The CIEH is a professional membership body representing over 10,000 members. It sets the standards for entry to the professional and maintains standards of competence and conduct through continuing professional development and through self-regulation. Its charitable and Royal Charter objective is to promote good environmental and public health.

8. Within the three domains of public health (health protection, health promotion and population healthcare) Environmental Health Practitioners (EHPs) are active in communities working holistically with partner organisations and community groups to support health protection and health improvement. Links with PCTs and GPs linked to healthcare services are less well developed but innovations like exercise on prescription often involve EHPs.

9. If the Committee wishes, the CIEH can provide a witness who can expand on the work of EHPs in collaboration with organisations like the Health Protection Authority(HPA)  and PCTs and across the range of local authority services.

10. At the national level of the new public health service, the abolition of the HPA and the setting up of Public Health England in the Department of Health does reduce the opportunities for independent advice and views to get through to the decision-makers. This is why the CIEH believes that a Chief Environmental Health Officer for England and an advisory committee overseeing the work of Public Health England will be needed.

11. If members look to the public health arrangements in Northern Ireland, Scotland and Wales they will see that the post of Chief Environmental Health Officer is central elsewhere. The CIEH can arrange for evidence about these arrangements if required.

12. In parts of England where there is two-tier local government (a county council and a number of district -sometimes called borough - councils), the Department proposes that the statutory duties and responsibilities and the ring fenced funding will be directed to the county council. However, the environmental health workforce is usually entirely with the district councils. Clearly there is a need for there to be arrangements to ensure that the Director of Public Health (located in the county council) can have access to this resource.

13. The Department, in line with the spirit of localism, believes that the local authorities in these two-tier areas will make arrangements to resolve this difficulty in ways that suit their local area. This is over-optimistic. The CIEH says that there needs to be a statutory duty to co-operate (in line with similar duties in respect of civil contingencies and safeguarding children) so that the county and district councils have to find a suitable way of working together. It remains open to the councils to make arrangements that suit their local area and the CIEH would anticipate that there will be a variety of solutions including joint agreements, shared services and supra-local collaborations.

14. In two-tier local government areas of England, it seems reasonable to the CIEH that the district councils should have a seat on the county’s health and wellbeing board by right. In keeping with the spirit of localism it should be for the district councils to work agree how to determine the representation. The Secretary of State has said that the challenge of co-ordinating public health services in two-tier local government areas will be through the health and wellbeing boards. It will also be open to county and district councils to agree for there to be a number of subsidiary health and wellbeing boards in the county – but this should not be a reason for excluding the district councils from the county’s health and wellbeing board.

February 2011