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The noble Baroness said: My Lords, the amendment would give the Commission for Health Improvement responsibility for public health services that are operated by NHS bodies and it would allow CHI to investigate a report on how well public health responsibilities were carried out by the NHS.
We have already had a significant debate today on public health—we did so in the context of primary care strategic health authorities and regional directors of public health. Those debates were led by my noble friend Lord Howe and the noble Lord, Lord Clement-Jones. There is one clear message from those debates—that there is considerable anxiety about how well the
I have two questions for the Minister. First, will the Government say whether public health is important? I know that that is a "motherhood" question; the Government will of course say that public health is important. However, if that is true, will the Minister say why the White Paper that was issued a couple of weeks ago, Delivering the NHS Plan, made no reference to public health? Some of us found that an astonishing omission.
My second question is harder. How do the Government show that they think that public health is important? My noble friend Lord Howe and the noble Lord, Lord Clement-Jones, displayed the confusions that lie at the heart of the Government's approach to public health—much rests on untried and untested public health networks which are run by primary care trusts. They are struggling to get the right quality and quantity of staff to handle those responsibilities. Above those bodies are strategic health authorities and regional directors of public health, with overlapping, and to some extent indistinct, roles. Many of us are sceptical about the efficacy of all of that and raise questions about how serious the Government are about public health if they are subjecting it to such a bizarre structure.
The amendment is designed to put some degree of oversight into public health, using CHI as the agent. If public health services are not working under those new structures, we can rely on CHI to say so.
When we discussed a similar amendment in Committee, the Minister said that the term "public health" was not statutorily defined and could be very wide indeed. My response is to say that a wide definition is exactly what the amendment would require. I have no problem whatever with the term bearing its natural meaning and not being artificially restricted. If the Minister has a specific definition in mind, I am sure that noble Lords will be prepared to consider it.
In Committee the Minister gave us some comfort by saying that the Government recognised that there was an issue in this regard. He said:
Lord Hunt of Kings Heath: My Lords, I am grateful to the noble Baroness for again raising the issue of public health. She asked whether public health was important to the Government. As she would expect, it is very important indeed.
She also asked how the Government showed their commitment in that area. If we look back to 1997, we can see a long series of actions that reinforce the critical importance of public health to the health of our nation. The list includes the development of area strategies in relation to inequalities in health; the work around sexual health; the issues that have been raised in a number of national service frameworks, many of which, as part of their overall strategy, focus on public health elements; the various targets that have been set; and the development of health action zones. That is a long and impressive list which we shall continue to develop in future. Indeed, I would argue that the Chief Medical Officer's announcement earlier this year of a plan for a health protection agency, which we discussed briefly in our earlier debate about public health, provides another example of how we wish to bring together some of the current national public health functions and co-ordinate them rather more effectively with what is happening at local level.
There can be no question about it: public health is important to the Government. We are confident—we debated this matter at some length earlier this afternoon—that from the arrangements that we are putting in place will come a far more powerful public health function because we have made the essential connection between public health and primary care. As noble Lords will know, I am confident that this is the right area on which to place much of our emphasis.
That said, I understand that the noble Baroness has raised a substantial question which, as I said in Committee, certainly needs to be given careful consideration, particularly in favour of giving recognition to the importance of public health services. As the noble Baroness knows, in Delivering the NHS Plan, we stated that a new commission for healthcare audit and inspection would be established. In the light of our discussions in Committee, we have decided—I am happy to assure noble Lords that this is the case—that we shall give careful consideration to the role that that new commission might have in relation to public health services, particularly where the public health responsibilities of primary care trusts are concerned.
However, the issues are complex in terms of clarifying the range of public health services that might appropriately be brought within the new body's remit, the relationships with both the bodies responsible for those services and those currently responsible for their inspection or regulation, and the legislative consequences arising.
The Bill before the House today gives CHI several important roles. At this stage, I should be reluctant to add to those roles in the way suggested by the noble Baroness without full consideration of the implications. However, I hope that she will accept my assurance that we are giving serious consideration to how these issues can be best taken forward, in particular in the light of our announcement about the new health inspectorate.
Baroness Noakes: My Lords, I thank the Minister for that response. I was pleased to hear that the issue of public health in the context of CHI or of a new commission is still live; that is, it has not been closed down. It is perhaps a matter of regret that the Minister will not accept the amendment now as the PCTs get under way with the new public health functions. As several noble Lords have said today, there must be considerable doubts about how they will work in practice.
Despite the optimism that the Minister has expressed, there are considerable doubts about how the system will work in practice. The ability to inspect the public health functions now would be a good arrow in the armoury of CHI. Nevertheless, I am at least pleased that the Government are still considering the matter, and I suppose that I can only say, "Roll on the next NHS reform Bill". I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Clause 14 [Commission for Health Improvement constitution]:
[Amendments Nos. 28 and 29 not moved.]
Baroness Noakes moved Amendment No. 31:
The noble Baroness said: My Lords, I rise to move Amendment No. 31, which seeks to create a new duty on the Secretary of State to give effect to patient choice. I should not like the Minister to think that my favourite bedside reading at present is Delivering the NHS Plan. However, I shall quote from it again. A whole chapter of Delivering the NHS Plan is dedicated to choice for patients. Paragraph 5.4 of chapter 5 states:
I should like to be able to take more time to explore the mechanisms—especially the financial mechanisms, which seem to be extremely complex—for giving effect to policies such as money following patients. I should also like to be able to explore the technology implications, especially given the Government's failure to date to progress the information
When we discussed this amendment in Committee, I had expected a warm welcome from the Minister. Now that the White Paper has been published, I expect a welcome that is considerably warmer than the one I received in Committee. What the Minister said then was,
"PUBLIC HEALTH FUNCTIONS OF THE COMMISSION FOR HEALTH IMPROVEMENT
The Commission for Health Improvement shall have such further functions as may be prescribed relating to the management, co-ordination, provision or quality of public health services for which prescribed NHS bodies, service providers, local authorities or other bodies have responsibility."
"the Government are giving serious consideration to how the issues can best be taken forward and to the extent that CHI's remit needs to be revisited in these areas".—[Official Report, 21/3/02; col. 1581.]
Since then, I have not heard or seen anything to diminish our concerns about public health. If anything, the lack of a reference in the White Paper increased our concerns. I hope that the Minister will say that the Government have considered the matter further and that they are minded to agree to the amendment. I beg to move.
After Clause 14, insert the following new clause—
"PATIENT CHOICE
It shall be the duty of the Secretary of State in carrying out his functions under the 1977 Act to ensure that, so far as it is reasonable for him to do so, persons who receive services under that Act are given a choice as to the time, manner and location of those services."
"For the first time patients in the NHS will have a choice over when they are treated and where they are treated. The reforms we are making will mark an irreversible shift from the 1940s "take it or leave it" top down service. Hospitals will no longer choose patients. Patients will choose hospitals".
Amen to that. However, I cannot resist pointing out that the roots of the policy lie in our reforms of more than a decade ago—reforms largely reversed by the Government after 1997. We rejoice that the Government have had a Damascene conversion to putting patient choice at the heart of their policies.
"I do not think that it would be appropriate to put the matter on a statutory basis. It is much more a question of policy to be decided by the Secretary of State."—[Official Report, 21/03/02; col. 1582.]
The Minister was effectively saying that patient choice might have been the Government's policy, but they wanted to be able to change it at will without the inconvenience of legislation. That seemed to suggest that patient choice was not a wholehearted policy of the Government. However, we now have the White Paper, and it suggests that patient choice is indeed a government policy which should supersede the Secretary of State's whims or transitory will. I therefore invite the Minister to put the issue beyond doubt by accepting the amendment. I beg to move.
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