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Lord Hunt of Kings Heath: This has been an interesting and important debate. I welcome the opportunity to discuss the amendments. Although I do not recommend that the Committee accept them, I recognise the importance of ensuring a cohesive public health system which enables us to tackle ill health, inequalities, surveillance and public protection. My belief is that our proposals in relation to public health will do just that.

First, the distinct advantage of the organisations that we propose is that there will be a strong public health team in every primary care trust, engaged with its own community, with local authorities and with non-governmental agencies—one that is very much focused on improving health, preventing serious illness and reducing health inequalities in the population that they serve. I believe that the combination of primary care and public health will ensure that they become powerful agencies for public health in the community.

Every PCT will have a director of public health on its board. This will be a high-level appointment. We expect the new posts to be taken up by public health professionals of the highest calibre. Regional directors of public health will have a key role in the selection process for the posts, to provide the necessary quality assurance.

For the first time, the director posts will be open to all suitably trained public health specialists, both medical and non-medical. In relation to the questions raised about the workforce and the numbers, my department is working at national level to strengthen the public health workforce and ensure that high-quality training programmes are in place to deliver the next generation of public health professionals.

As I have said, the new role of public health in primary care has enormous potential. The new directors of public health up and down the country will be the engines of public health delivery. The focus of their activity will be on local neighbourhoods and communities, leading and driving programmes to improve health and reduce inequalities.

It will be the job of the public health teams in primary care trusts to ensure that maximum health improvement is brought about by prevention and other interventions. In addition, the director of public health will be accessible to the local media to explain health inequality issues. The DPH will have a team whose composition will be a matter for local determination. They will seek to ensure that the public health role of the primary care workforce—including health visitors, school nurses, health promotion and other community workers—is fully realised by encouraging practitioners to lead specific programmes.

A number of speakers mentioned the public health networks. I agree that these are of importance. Essentially, the public health networks will provide the specialist expertise which cannot be provided in every

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single primary care trust. The idea of the networks will be to pool expertise and skills in specialist areas of public health which can then be available to all primary care trusts, to share good practice, to manage public health knowledge and, importantly, to act as a source of learning and professional development.

I want to make it clear that this will not be an additional tier of NHS management; nor will it adhere to rigid professional boundaries. The networks will be flexible and responsive, and they will change and evolve over time. For example, a network will be able to respond to cities for public health advice and action programmes. New NHS structures will not be able to match every local authority boundary, but a flexible, responsive network will, for example, be able to support the Health Cities initiatives, so vital in many parts of the country.

This country has a long and highly respected tradition in academic epidemiology and public health. It has been vital in contributing to the knowledge base for disease prevention. Academic departments of public health in the universities, with and without medical schools, have also played a vital part in education and training. We want to ensure that those academic strengths are preserved and maintained in the changes.

It is important that the existing public health research and development funding by health authorities continues to be spent on public health R&D, and we are considering the most appropriate management arrangements to enable that to happen. Public health networks will also include non-governmental organisations which have a key role to play in improving health and reducing inequalities, and also in dental public health.

One question that is apposite to public health at the primary care trust level—a question asked by the noble Earl, Lord Howe—relates to the lead public health officer in an area where two or more primary care trusts cover the area of one local authority. My understanding is that the directors of public health serving that area, working within the local public health network, decide and agree on the best arrangements for ensuring the high-quality advice to each individual local authority. That will include named lead public health officers.

At the strategic health authority level, there will be a senior public health doctor in every health authority as a member of its top team. They will have a distinctive performance management role in relation to the constituent NHS organisations within their boundaries, including, of course, primary care trusts and the public health role of those primary care trusts.

While not duplicating the work of directors of public health in primary care trusts, strategic health authorities will have responsibility for performance management of public health action within primary care trusts. In order to discharge that, each strategic health authority will need a medical director/public health doctor with the appropriate strategic management skills to undertake this function as a member of its top team.

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From April 2002 at the regional level there will be a regional director of public health and a support team in each of the regional offices of government to provide the Department of Health's public health function. The senior officers and the teams will have a wide-ranging role: they will manage and co-ordinate the health protection and emergency planning functions in their regions; they will design, develop and maintain public health networks; and they will tackle the root causes of ill-health inequalities through the health component of cross-government policies in the regions. Overall, regional directors of public health will be accountable for ensuring that appropriate high quality health protection arrangements covering infectious diseases and other risks to health are in place in all locations in their regions. They will also be accountable for managing and co-ordinating the health aspects of the Government's response to emergencies and disasters.

In addition, I refer to the Chief Medical Officer's proposals, which were announced on 10th January and which are designed to streamline the services involved in the prevention and the control of infectious diseases. The proposed health protection agency will provide an integrated approach to all aspects of health protection, including chemical and radiological hazards as well as infectious disease control. The agency will take over functions that are currently performed by the Public Health Laboratory Service to which I pay great tribute. I hope my noble friend Lord Turnberg will convey that to the PHLS. The National Radiological Protection Board, the Centre for Applied Microbiology and Research and the National Focus for Chemical Incidents will also assume responsibility for employing consultants in communicable disease control.

The new agency will work closely with regional and local services and the expert government advisory committees. The new agency will also work with CHI where there are serious deficiencies in standards of infection control in hospitals, primary care or other health service premises.

I recognise the crucial importance of surveillance. The CMO's strategy makes that clear as regards infectious diseases and environmental hazards. We envisage that the new health protection agency, proposed in the CMO's strategy, will have a key role in surveillance of infectious diseases and environmental hazards and, as part of that, will work through the NHS to decide what role other players should have in surveillance.

I do not believe that it is desirable to write the requirement to carry out surveillance into primary legislation. It can be dealt with through secondary legislation, which will allow more flexibility over the precise form that the requirement should take. The responsibility for systems for monitoring the health status of the public is much wider than the role of strategic health authorities. As I have indicated, there is a crucial role to be played at the primary care trust level and at the regional level.

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The public health functions of PCTs are set out clearly in the Next Steps paper. To set them out in statute is neither necessary nor appropriate as the achievement of health improvement and reductions in health inequalities cannot be accomplished by PCTs working alone.

I hope that noble Lords will recognise from what I have said that the Government consider that a cohesive integrated approach to public health is important and essential, and that each part of the new public health system, whether at the primary care trust level, in networks, at strategic health authority level or the regional level, or in the new health protection agency, as announced by the Chief Medical Officer, will ensure that we have a safe integrated function.

As my noble friend Lord Turnberg has said, I recognise that a great deal of detail needs to be talked through and developed. I am happy to meet him, and other noble Lords who are interested, between now and Report stage to fill in some more of the details. I am confident that the approach that we are taking will provide a strong public health element at every level of the NHS and the required protection that the public so richly deserve in what I accept is an important area.

6.45 p.m.

Baroness Cumberlege: I thank the Minister for such a clear exposition of how this matter will work in terms of the public health function. However, I am concerned about one point. The Minister said that at the PCT level the public health officer may not be a doctor—it could be anybody. Obviously it would be someone with a good qualification, but not a medical qualification. Is that a wise move? I understand that all kinds of people—geographers—may have an interest in looking wider in terms of public health, but I wonder about the credibility of such people among other medics whom they will have to lead and influence. We know that at times the medical profession can be chauvinistic. I am anxious that the system is robust and that we do not have a woolly social scientist who will have no credibility with the medical profession.

A new agency will be set up and my heart warms to that in terms of the debate that we had earlier in Committee. But I wonder how the Health Development Agency, which was the successor to the Health Education Authority, will work with the health protection agency and all the other bodies that will be set up. Can the Minister tell the Committee what the Health Development Agency has achieved, if anything?

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