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Lord Clement-Jones: I shall speak to Amendments Nos. 43, 45, 49 and 51, which fall into two categories. Amendments Nos. 45, 49 and 51 are probing amendments to ascertain whether the PCTs are ready for the role that is being thrust upon them.

I must correct the Minister's earlier statements. He seems to believe that if one states that PCTs are not ready for a particular role, that is centralist. The noble

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Baroness, Lady Noakes, made that point. I should like to reinforce it. The Minister is developing a mantra about centralisation, which needs to be killed at the first possible moment. It is not centralist to query whether such a body is ready. It is not centralist to place a duty on a PCT if the responsibility is performed at that level. However, it must be properly performed, and a PCT must have the resources and expertise necessary to fulfil that responsibility.

There are major implications for public health services in this Bill. There is very little explicit reference to them. Public health directors will soon move from area health authorities to PCTs—on 1st April 2002. Who will fill all these roles? Will they be filled in time? What qualifications are necessary? How will PCTs deal with public health specialisms which have been built up over a number of years? What consultation has there been with public health professionals over these changes? As the noble Earl, Lord Howe, said, how does this fit in with the proposed new national agency?

In a speech which seems to be the one point of reference most public directors have, the Minister plays a considerable role with regard to how reorganisation will take place. That is perhaps flattering for the Minister, but not totally helpful for all the public health professionals affected. It is far from clear what resources PCTs will have.

The King's Fund, in its helpful way, is producing some valuable work, showing the problems that PCTs will have in taking on new public health responsibilities. Its document, launched on 26th March, is entitled Public Health in the Balance. We await that with bated breath. The King's Fund makes a hefty contribution to whatever it espouses. The title alone sounds as though it intends to publish some fairly formidable conclusions.

Devolution of public health functions has been uneven. There are concerns about specialisms being lost. Staff vacancy rates may hamper PCT efforts to deliver public health. Responsibilities for different aspects of public health are blurred, as the noble Earl, Lord Howe, has mentioned. All these difficulties need to be overcome if PCTs are effectively to discharge their public health functions.

I offer the Minister two solutions. First, for a while, exclude public health from the duties of PCTs, so we can get it right in a proper fashion. That would be my preference. Secondly, place on PCTs the kind of duties suggested in Amendment No.43 which is cognate to the amendment put forward by the noble Earl, Lord Howe.

Amendment No. 43 arises from the fact that the arrangements are by no means clear to ensure that health protection and health improvement duties are fulfilled and that the necessary resources allocated. The Government have failed to articulate how these public services should be organised to ensure co-ordinated delivery of programmes for health improvement, health protection and prevention programmes by the National Health Service at each level.

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Who will be the lead public health officer where one local authority is served by two or three PCTs? The current reorganisation of the National Health Service has yet to produce clear operational guidance on how the three key public health functions should be run and be connected with regional and national tiers. Public health networks have been mentioned, but their formal relationship to statutory entities in the National Health Service and local authorities is not clear.

Some key questions remain on public health duties and on how this reorganisation will work. How will the Government ensure that a cohesive and balanced public health service will deliver its challenging policy commitments? How will they ensure that all these components are integrated at local, regional and national levels? The collaborative arrangements between local government and National Health Service bodies are archaic. How and when will the law be updated? What will be the relationship between public health networks and PCTs and how will they be funded?

Baroness Masham of Ilton: It is very important to have the expertise of trained doctors in public health in primary health care trusts and strategic health authorities. Are there enough trained personnel in place to deal with the rising number of cases of tuberculosis in various parts of the country and the worrying rise of the many sexually transmitted diseases, such as chlamydia, gonorrhoea, HIV, AIDS, variant CJD, food poisoning, and water-borne infections such as cryptosporidium, together with an increase in alcohol and drug abuse?

We need an increase in health education, and public health needs should be pushed up the health agenda, not fragmented within inadequate departments with too much responsibility piled on them. There are not enough experts to deal with some of these very difficult and important public health matters. I hope that the Minister will give us some positive assurances tonight that public health will be adequately financed and organised to do its job.

Lord Turnberg: One of the key elements of a public health agenda is to protect the public against infectious diseases: food poisoning, meningitis, HIV, AIDS, TB and so on. A large number of different professionals are involved in that activity, including GPs, primary care trusts, environmental health officers, consultants in communicable disease control and regional epidemiologists. There is also the Public Health Laboratory Service through its local microbiological laboratories, specialist reference laboratories, the Centre for Disease Surveillance and Control, as well as the National Health Service trust laboratories. I declare an interest as chairman of the Public Health Laboratory Service.

Primary care trusts clearly have to have a role. They are right in the middle. But they will have their work cut out to deliver what to them are relatively new activities. My anxieties increase when we know there will be considerable change in the way the PHLS

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network will run as the new health protection agency takes over in April 2003. The PHLS will cease to exist and the laboratories will be largely handed over to individual local National Health Service trusts.

There will be two almost simultaneous changes in the surveillance for communicable disease; in the primary care trusts taking up their new role and in the laboratory services as these trusts take over. Some degree of caution is required and special attention must be paid to this potentially hazardous transition period. I am encouraged that my noble friend the Minister is acutely aware of these difficulties and that there will be opportunities to discuss how they may be obviated. I very much look forward to that.

6.30 p.m.

Baroness Finlay of Llandaff: Perhaps I may quote the remarks of the president of the Faculty of Public Health Medicine, London, Sian Griffiths. She refers to concern among public healthworkers from multi-disciplinary backgrounds and states:

    "Since last April they have not known where they will be working on 1 April 2002. Working in public health requires a long term view".

Difficulty arises in relation to the long-term strategies to ensure equity in health and health prevention issues in the nation; and there are the infection control issues that have been referred to. There is also the problem of acute infection, in relation to which public health laboratories must form part of our national defence. We have already had scares about threats to our national defence through infection, so the co-ordination of these services is crucial.

As Sian Griffiths has said,

    "if this reorganisation is not to weaken the public health function a sustained input of energy, time, and resources will be needed from the government to promote [the agendas required of the service]".

Baroness Pitkeathley: For the avoidance of doubt, I should state that I occasionally act as an adviser to a company providing healthcare. I am also chair of the New Opportunities Fund, which is investing £300 million in about 300 healthy living centres which are examining public health in its widest sense.

I am fully supportive of the idea of making public health central to the NHS. However, I do not believe that the amendments are necessary. It seems to me that the Government have demonstrated their commitment by ensuring that each primary care trust has a director of public health. We must also remember that public health goes far wider than what we normally think of as healthcare. It includes such issues as access to transport, access to information, and the environment, as well as issues of neighbourhood. Having a regional director of public health in each government office reminds us of the much wider agenda on the public health issue.

The duties of PCTs in relation to public health are clearly stated—and I believe that they are understood. Indeed, I am impressed by the number of primary healthcare trusts which are already taking up those responsibilities, and taking them very seriously in

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terms of being responsive to the health needs in the widest sense of their local community—which is, after all, why they were set up in the first place.

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