The Government’s White Paper proposals for the reform of Health and Social Care Contents

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7Public health

118.The White Paper states that the Government will “in due course” publish an update on proposals for the future design of the public health system, including the establishment of the new National Institute for Health Protection.178 This will include legislative measures to:

• Make it easier to secure rapid change updates in NHS England’s public health functions including powers to restrict the advertising of high fat, salt and sugar foods.
• The introduction of a new power for Ministers to alter food labelling requirements.
• The return of responsibility for the fluoridation of water in England from local authorities to central Government.179

119.The White Paper stated that:

Local government delivery is also rooted in firm foundations: in serving its residents, with strong local democratic accountability, and expertise in the health, public health and care needs of its populations. To protect these principles, which are so close to all our hearts, we must back those who make them a reality every day of their lives—by building and constantly renewing a culture of collaboration.180

Obesity

120.The UK Faculty of Public Health welcomed the measures in relation to obesity,181 while the Association of Directors of Public Health agreed with proposals for further restrictions being placed on the advertising of products high in fat, sugar and salt, and better food labelling requirements.182 The Local Government Association was also in favour of the proposals, but cautioned that local authorities needed to be “an equal partner” in the design this work and that it needed to “build on existing sector led improvement work”.183

121.Nigel Edwards from the Nuffield Trust agreed that there was “a very clear role” for local government in the development of the proposals for public health,184 while Richard Murray recognised the potential “tension” between consistency around governance and accountability while retaining some of the local flexibility”.185

Mental health and Wellbeing

122.Richard Murray, King’s Fund believed that the reforms also had the potential for mental health and wellbeing “to be focused on at a population level”. However, he saw a risk that this could “fall by the wayside” should the focus of the NHS and the ICSs be on reducing waiting times.186 Carers UK also highlighted wellbeing and argued that a specific duty be placed on the NHS to have regard to carers and to promote their health and wellbeing.187 National Voices also wanted to see “much clearer commitments” to strengthening health and wellbeing and health inequality throughout all areas of local and national policy and spending and believed that the Bill presented “an opportunity to make this real”.188

123.When we he came before us, the Secretary of State said that ICSs “absolutely will have a duty to look out for people’s mental as well as physical health” and that placing that duty on the face of the Bill would be something to be debated during the passage of the Bill through Parliament.189

Fluoridation

124.We received contrasting views in written submissions in relation to the proposals on fluoridation. Both the British Dental Association and the Association of Directors of Public Health welcomed the proposal,190 while the Association of Dental Groups described a national programme for water fluoridation as “the single biggest preventative measure that could be taken to protect the nation’s oral health in the future”.191

125.That said, a number of submissions recognised that any national programme would need careful handling. The UK Faculty for Public Health broadly supported the proposal but argued that it “must not be imposed on communities without their consent” and should only be introduced after public consultation.192 This view was echoed by the Local Government Association who argued that water fluoridation “must not be imposed on communities” and that local decision-makers were “best placed to take into account locally-expressed views and to balance the perceived benefits of fluoridation with the ethical arguments and any evidence of risks to health”.193

126.We also received submissions from organisations and individuals194 opposed to water fluoridation. The UK Freedom From Fluoride Alliance set out its opposition to the fluoridation of water but stated that should it continue, “the issue should remain in the hands of the Local Authorities in whose area a new proposal arises”.195 This position was supported by Hampshire Against Fluoridation which believed that any decisions had to be decided by local elected representatives “who know the local situation and are directly responsible to the people in the area”.196 Bromsgrove for Pure Water also described the proposal as “ill-considered”.197

127.We are broadly supportive of the proposals in the White Paper on public health although did not consider them in detail. Therefore, we do not make detailed recommendations on the potential merits of the individual proposals. However, we conclude that there are wider health benefits to including in the Bill a duty to be placed on ICSs to have specific regard to public health, mental health and well-being and the prevention of ill-health.

128.We recommend that the Bill include provisions to place a core duty on ICSs to have regard to public health and mental health; and to include in ICSs’ public health duties, a requirement to develop strategies to ensure the prevention of ill-health through the delivery of programmes to support the wellbeing of the local community, health and care staff and voluntary organisations that support the health and care sector.

129.We welcome the direction of travel in the White Paper’s proposals to tackle obesity. If this is to be successful, the proposals on food advertising should reflect the fact that the viewing habits of children and young people are not restricted to television but extend to social media and online providers of content.

130.We did not consider the fluoridation proposals during our evidence session. That said, it was covered by a number of submissions from both individuals and organisations that were opposed to the proposal and several clinical bodies that were in favour of it; and we draw the Department’s attention to that evidence. The Secretary of State will recognise the long-standing debate on fluoridation, and we look to him to set out a balanced response to both sides of the argument during the debates on the Bill.