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The Deputy Chairman of Committees (Lord Lyell): I apologise to the Committee; I should have raised two housekeeping points relating to this group, which I hope are acceptable. If Amendment No. 25 is agreed to, I would not be able to call Amendment No. 26. Furthermore, I am advised that Amendment No. 26 has been misprinted and should read, "leave out", but miss out the word "from". Those two housekeeping points may be of interest to noble Lords as matters of detail; nevertheless the amendment has been moved.

6.15 p.m.

Baroness Barker: I rise to speak to Amendment No. 27, which is an amendment to Amendment No. 26. I echo everything said by the noble Earl, Lord Howe, about his amendment.

The brevity of the clause is fine. I have no wish to pre-empt what the Minister will say but no doubt she listened closely to the words of her noble friend when he addressed an earlier amendment and pleaded the cause of a lack of detail allowing greater flexibility. Nevertheless, the points made by the noble Earl, Lord Howe, are valid. A great number of bodies are involved in health protection in its wider sense. There is a case not only for making them more explicit, but for adding to the list the names of the two bodies we have identified in our amendment.

The first is the Chief Medical Officer. The inclusion of the Chief Medical Officer on such a list goes without saying. Indeed, in the Government's response to the report on fighting infection, on page 31 one finds a most interesting press notice of 9 June 2003 stating that the CMO is to step up the fight against hospital infections. It does not go on to say that the CMO is doing it alone—it suggests that there is a team behind him—but, nevertheless, it is a small indication of the importance of the Chief Medical Officer in the whole process.

I agree with the noble Earl, Lord Howe, that the concern is not only about the range of bodies involved in health protection, but where the accountability for co-ordination lies and where exactly the buck stops. Quite often the buck stops with the Chief Medical Officer.

In addition, we have included Defra in the list. I have no wish whatever to repeat the debate we had earlier today on zoonoses—fascinating and grammatically correct though it was—but there is a particular reason for including that department. Within Defra there is now the Drinking Water Inspectorate and quite a number of the infections we are discussing are water-borne. So there is a clear technical reason for Defra to be involved.

Moreover, as those who have read the report on fighting infection, Getting Ahead of the Curve, will know, at the last count, made when the report was

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published, some 400 diseases could be transmitted from animals to people. I am sure that number has risen by now. No one needs to go over in any depth at all the importance of farming now to public health.

I agree with the noble Earl, Lord Howe, that it is important to state the names of these bodies quite clearly, not least because there is a need for the public to know the range of responsibilities for public health. Part of the reason for that is because the reporting of instances of infectious diseases does not always happen within the health service. People may go to their GPs, but if they come across environmental infections they do not quite know where to go or what to do. I believe that there is a public education and information role, which is important in a list like this. Those who are in the business clearly are in the know. Those who are not in the business could do with a bit of explanatory help, which is important.

Baroness Finlay of Llandaff: My name is added to the amendments spoken to by the noble Baroness, Lady Barker. I have a slight concern about having a list in a Bill such as this. Public health is everyone's concern. Just about every department can be seen to impact on public health. For example, buildings and bad air-conditioning systems lead to Legionnaire's disease. We also know about the impact of bad housing, poor transport and so forth on health.

While I commend the noble Earl, Lord Howe, for extracting a list of key players, I have a slight reservation that if someone is not on the list, it might be said that public health is not their major concern. I should like everyone to be concerned with public health in every government department. However, the reason I put my name to the insertion of the Chief Medical Officer and Defra obviously relates to zoonosis and the very specific responsibilities there.

I should also like to draw attention to the bodies established outside the United Kingdom. The relationship for our public health services with their colleagues in the World Health Organisation is crucial to our being able to function effectively. It is not only about the exchange of information, it is also about personal relationships and knowing who to contact very early on when there is an index of suspicion, but long before there is any alert. Those interpersonal relationships have stood us in good stead.

I remind Members of the Committee that Dr Meirion Evans's work on SARS was commended. He comes from these isles and had a huge influence on the handling of that epidemic. Those interpersonal relationships are extremely valuable. In having a specific reference to bodies outside of the United Kingdom, I hope that the Bill will empower the agency to work more closely with the WHO. When I visited WHO with the Select Committee on Science and Technology, we were concerned that, from the WHO perspective, there was not as much placement of our professionals and expertise on secondment as it would like. We may miss out if that is not increased.

Baroness Masham of Ilton: Only yesterday, with regard to a Question about Munchausen syndrome by

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proxy, the Minister said how important it was for bodies to work together. I am sure that he will be interested in this amendment or Amendment No. 26. One never knows what will be around the corner: one only has to look at cryptosporidium in water, which suddenly appears in different parts of the country. As regards Amendment No. 27, we must consider BSE and what it has done to the country. It has cost billions of pounds. There are so many issues; it is better therefore to have a blanket and have them all there, rather than to leave some out.

Baroness Andrews: I have enjoyed this debate. It has been about the nature of life and accountability, as well as the nature of legislation and what it can and cannot achieve. In itself, that has been interesting. I am sorry that I shall be addressing a slightly narrower scope than the noble Earl addressed in his wide-ranging speech.

My noble friend Lord Turnberg pointed out earlier that one could invent all the structures in the world. Ultimately, delivery happens through people co-operating effectively within sensible structures. It is important to keep that in mind.

The noble Earl raised several specific questions about the nature of those relationships and how they would work in the absence of service agreements; that is, how things would be governed. Perhaps I may reflect on what he said and respond in writing to some of the more specific queries which I cannot address now.

However, I shall answer his point about civil contingency. The noble Earl made the distinction between the routine work of the agency, which is extremely important in terms of surveillance and the emergency response. Part 1 of the Civil Contingencies Bill is concerned with preparedness for contingencies and covers the HPA, so clearly there is a relationship in place. However, Clause 5 of the Bill before us applies to all HPA activities, thus providing a sound locking-in of the two functions.

We should not forget that the creation of the HPA in itself addresses some of the major questions raised by the noble Earl. I can say that we appreciate the concern of all noble Lords and we are sympathetic to the intentions behind these amendments. However, the sad fact is that the amendments themselves do not achieve what is being sought in two quite specific ways.

First, Amendments Nos. 24 and 25 would make the duty of co-operation one-way, which is a contradiction. Here I address the point raised by the noble Baroness, Lady Masham: we are certainly in favour of co-operation, but co-operation is a two-way street. The agency would be obliged to co-operate, but other bodies would not. That could seriously hamper the agency's effectiveness, so we must be able to ensure that all the relevant bodies are under a duty to co-operate. Special health authorities are already under a duty to co-operate with NHS bodies and local authorities. Section 26 of the Health Act 1999 puts NHS bodies under a duty to co-operate with each

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other, while Section 22 of the National Health Service Act 1977 creates a duty of co-operation between NHS bodies and local authorities.

Therefore, aside from the difficulties arising from the accidentally exclusive nature of the amendments, is the fact that the Bill is consistent with the way we are used to dealing with the issue of co-operation. We have had several examples this afternoon, not least those cited by my noble friend, of how co-operation operates so successfully in practice. It is due to goodwill and sensible structures.

Secondly, we have to face the curse of the list. Almost every health Bill provides, with the best of intentions, the temptation to prescribe inclusiveness. The noble Baroness raised a point about public information and education. While I see the aim, I would argue whether setting out a list in legislation is the right way to inform people. There are many ways in which we can be open about co-operation and what effects that will have. However, a list set out in legislation is not necessarily the best way to reach people, even when it flags up such august persons as the Chief Medical Officer and brings in Defra. To include such persons and bodies would mean that, technically, we should add to the list everyone engaged in infection control. We would have a very long list.

I want to address precisely the issue raised by the noble Baroness about the range of bodies that would have to be included. This list, however forbidding in length and complexity and however thoughtful in substance, is not complete. For example, no reference is made to the health and social services boards in Northern Ireland, or to the Northern Ireland health and safety bodies. Moreover, as new bodies are formed, the list would become even more incomplete. Were we to go down this road, how would we keep the list up to date? Who would we include and where are the boundaries of public health? The list would have to be amended by further primary legislation, a point noted by the noble Baroness, Lady Finlay.

I conclude by referring to the second point made by the noble Baroness. The amendment would not achieve what I take to be its aim; that is, by identifying by name all the specific bodies affected. I would challenge the notion of vagueness and unnecessarily robust generality here. That is how new international bodies should be able to be included, for example, as well as the WHO, obviously, with which we have worked and continue to work extremely closely.

For all those reasons, I hope that, bearing in mind what I have also said about trying to answer some of the noble Earl's more specific questions, he will see fit to withdraw his amendment.

6.30 p.m.

Baroness Masham of Ilton: With all their machinery behind them, the Government could find a way to embrace all the bodies so that none is left out, without listing them individually. That would cover them all before the next stage of the Bill's consideration.

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