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For those reasons I strongly resist Amendments Nos. 47 and 48, which would rename the Mayor’s “health inequalities” strategy the “public health” strategy. The term public health is too broad and potentially covers a range of aspects outside the remit of the GLA. For the same reasons, I resist the related Amendments Nos. 51 to 53, which seek to change the specifications for the strategy in similar terms.
I could go on about the consequential amendments, but I shall turn to Amendment No. 70, which would remove the duty on the Mayor to have regard to health inequalities in relation to mayoral strategies and to include in his strategies policies and proposals best calculated to promote a reduction of health inequalities. I come back to my point that we are focusing on the aspects of mayoral influence that affect public health in the widest possible sense. These concentrate on health inequalities.
Amendment No. 60 simplifies the consultation process on the Mayor’s health inequalities strategy. Clause 22 requires the Mayor to consult the health adviser and bodies in London’s health sector about what he should include in the strategy. In doing so, it requires him to publish a final draft. We believe that it is unnecessary to require the Mayor to publish a final draft of the strategy in order to consult about what should be included in it. We are therefore removing new Sections 309G(6) and 309G(7) to make the consultation requirements more straightforward.
I urge the noble Baroness to consider withdrawing her amendment and having a meeting to discuss what we have highlighted in this debate.
Baroness Gardner of Parkes: Is the Minister at all concerned, as I am, that the list of determinants might mean that the Mayor feels that he can call on his powers, which she has said he will have, to interfere with whatever other boroughs are doing? One of the concerns of boroughs in London is that they might find that they cannot do as good a health job as they are doing with their own social services and health departments because he would be interfering and saying what they should be doing. It is all very well to give him influence—everyone is very happy for him to have influence—but I would want to be sure that he does not have powers to supersede or overrule what local boroughs think is right.
Baroness Morgan of Drefelin: As I understand it—I may need to correct myself—the mayoral powers are set out in the 1999 Act. We want to produce a strategy that would influence the other strategies that the Mayor is involved with. I am aware that others
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Baroness Hanham: Health inequalities are very wide, and I know that we have had lots of discussions in our borough about them. My noble friend Lady Gardner has triggered an anxiety in my mind that boroughs will have to work in conformity with a lot of the other strategies, and it depends on how this strategy is constructed. The Mayor has influence over transport, housing and education, all of which are included in the health inequalities strategy, but he will not be able to deliver—the boroughs will have to. I wonder what that level will be.
Government Amendment No. 60 would remove the provision that ensures that the Mayor produces a final draft. Does he have to produce any draft at all before he gets to the final draft? If there has been nothing for the Assembly to look at before it gets to the full consultation document, there is no possibility of amending it before it goes to consultation if the final draft—if it is the only one—is removed.
Baroness Morgan of Drefelin: The noble Baroness has picked up the key question. The idea of producing a final draft could have been perceived as a contradiction in the way in which the consultation was planned. On the health inequalities strategy, it is envisaged that the Mayor will seek to achieve results by influence and persuasion; he has no powers of implementation. It is, as the noble Baroness has said, about local delivery. Under our amendment, a final draft for the purposes of initial discussion would be produced and would be available before the Assembly considers it. I hope that that clarifies the position.
Baroness Hanham: I hear what the Minister says. I presume that this amendment will not reappear now that it has been moved by the Government and will presumably be accepted. It is a pity, because we have not really discussed at any length the Government’s intention for that consultation. That is my fault.
I thank the Minister for her reply. The discussions she has offered will be helpful; it will be useful to see how these strategies are working. I have no doubt that what is being suggested is as it should be, but it would be very nice to see how the Mayor will do it. If I need to table the amendment again so that we can discuss it again, perhaps we can do it in a way which will be helpful as much as begging the questions. For today, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
[Amendments Nos. 45 and 46 not moved.]
Clause 22 [The health inequalities strategy]:
[Amendments Nos. 47 to 53 not moved.]
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Baroness Hamwee moved Amendment No. 53A:
“(h) a London Borough Council,(i) the Common Council.”The noble Baroness said: The amendment would make the London boroughs and the City relevant bodies under proposed new Section 309E(5). This is a gently probing amendment; I do not want to cast myself among those who would like to see more mayoral control of the boroughs. However, it is an opportunity to ask how the Government see the borough role in this arrangement.
The amendment is tabled at the request of three organisations dealing with visual impairment—the Guide Dogs for the Blind Association, the RNIB and the London visual impairment forum. They sent me a six-page briefing, which I shall not share with the Committee at this stage. It makes important points about access to care services and the role of local authorities, particularly rehabilitation and the need for properly trained staff in adequate numbers. I know that the noble Baroness, Lady Darcy de Knayth, will speak in more detail on the matter; she has far more experience than I do in this area of health. I beg to move.
7.30 pm
Baroness Darcy de Knayth: I, too, have been sent the six-page briefing and I will also spare the Committee most of it. In any case, the noble Baroness, Lady Hamwee, gave a good idea of what it is about. She has huge experience of local government and London, and I have neither. I apologise for coming to the Committee late but I was in a meeting. I wish that I had heard the whole debate on Amendment No. 44.
I know how important it is to have the right treatment and equipment at the appropriate time in the rehabilitation of someone with a locomotor—from my point of view—or sensory impairment. That is essential if they are to be successfully rehabilitated and able to stay as healthy and mobile as possible, achieve their maximum potential and make a contribution to the community.
My noble friend Lord Low is very sorry that he cannot be here. He is in Australia. He very much approves of this amendment and says that he backs it. He agrees that there is a severe shortage of rehabilitation officers.
The briefing is interesting. It states that 94 per cent of local authorities in England do not employ staff who carry out holistic assessments of individual need on the visually impaired. They are much disadvantaged. The majority of rehabilitation workers are qualified to undertake a specialist assessment of needs arising from a person's vision loss but they have neither the training nor the experience to carry out a more detailed assessment of other needs, such as those resulting from physical or mental health problems.
Other visually impaired people may be assessed by a generic care manager with experience of physical or mental health problems but extremely limited knowledge of needs arising from visual impairment. You do not
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The Government are keen to encourage local authorities and health providers to work together. I appreciate what the noble Baroness, Lady Hamwee, said and I heard a little of the previous debate, but I hope that we hear something encouraging from the Minister.
Baroness Hanham: On a narrow point, the amendment moved by the noble Baroness, Lady Hamwee, would include London borough councils and the “Common Council” in the list in subsection (5), as paragraphs (h) and (i). I support that, because they seem to be excluded.
Baroness Morgan of Drefelin: I should like to respond very warmly to the debate that we have just had. The Government would like to think about this amendment. The noble Baroness seeks to add London borough councils and the Common Council to the list of relevant bodies and persons. In the light of the Local Government and Public Involvement in Health Bill, which will require upper-tier local authorities, such as London boroughs and primary care trusts, to produce joint strategic means assessments of the health and social care needs of their local population, we agree that it would be sensible to include local London boroughs and the Common Council in the list of relevant bodies and persons. This is because they are likely to have a role in implementing the health inequality strategy.
However, the list of relevant bodies and persons, except for the authority and functional bodies, is also referred to later on for the purposes of consultation on the preparation or revision of the strategy. The authority and functional bodies are exempted from the list for the purposes of such consultation as they are already named as consultees under Section 42 of the Act. If the boroughs and Common Council were to be included in the list of relevant bodies, like the authority and functional bodies they would need to be exempted for the purposes of consultation, as they too are listed as consultees in Section 42.
We would like to consider the amendment further because there are some drafting problems. I hope that the Committee will give us that opportunity.
Baroness Hamwee: I am obviously grateful for that. There are more than just drafting issues involved. I hesitated about tabling the amendment, because it raises the issue of what the Mayor can direct the boroughs to do. That takes us into a whole other area of debate, quite apart from the matters with which these organisations are particularly concerned. I am grateful to them for raising the question of what the relationship is expected to be, because that is not wholly clear.
Of course, the forthcoming local government Bill will impact on this issue, so we need to consider it in the round. I had thought of it far more widely than as
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Amendment, by leave, withdrawn.
[Amendments Nos. 54 and 55 not moved.]
Baroness Hanham moved Amendment No. 56:
The noble Baroness said: The amendment relates to the general health determinants that are used to judge health inequalities. We are concerned with the possible discriminatory effect of the wording,
There is certain justification for the other determinants and the wording, but this one could be misinterpreted and it might be helpful to have an explanation from the Minister. I beg to move.
Baroness Hamwee: I support the amendment. I, for one, would not like to be told by the Mayor how to live my life to the extent that this suggests.
Baroness Morgan of Drefelin: We will resist the amendment. As we have just heard, the amendment would remove,
from the description of “general health determinants” in relation to the health inequalities strategy. The specific listing of “general health determinants” such as the use of,
This amendment should be resisted, as retaining this sweep-up provision at the end of the definition would serve to ensure that other aspects of personal behaviour, such as physical activity, would not be excluded without the inclusion of an all-encompassing list.
You can look at this issue from two perspectives. If you try to have an inclusive list, you can leave important issues out and that can become a problem. It is not an uncommon approach. With that in mind, I hope that the noble Baroness will withdraw her amendment.
Baroness Hamwee: I would like to be assured that the words in subsection (5)(d),
- “that are determinants of life expectancy or the state of health ... other than genetic or biological factors”,
apply to the list in paragraphs (a) to (d). As drafted, it could be regarded as applying only to “other matters”. That was why I reacted against the reference to the phrase,
That phrase needs to be conditioned in this way; otherwise it is unacceptably wide.
Baroness Morgan of Drefelin: Yes, that is the case. I hope that that offers some reassurance.
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Baroness Hanham: We may need to return to this because it sounds as though this clause needs amending. The trouble is that the drafting conjures up a lot of possibilities. This health strategy must not become an interference in people's lives. We need to make sure that that provision is amended.
Baroness Morgan of Drefelin: It is not the policy intention that we create a huge inappropriate list. I will write to the noble Baroness to pick up on this issue and offer some further background.
Baroness Hanham: By all means, but I am not the one who matters; at the end of the day, this legislation is for everybody not just for me. If I do not understand it and the Government have to explain it to me, they will have to explain it to the world. The world will misunderstand it. That is why I object to this drafting. We may be able to find a happier way of describing it that also encompasses the amendment tabled by the noble Baroness, Lady Hamwee, which we can then use to amend the clause at a later stage. I would feel extremely uncomfortable if the clause were left in the Bill as it is. If we can agree to have a discussion about it, I will beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Baroness Hanham moved Amendment No. 57:
The noble Baroness said: Proposed new Section 309G would require the Mayor to have regard to guidance from the Secretary of State as to matters he should take into account in preparing or advising the health inequalities strategy. The amendment would delete that provision, largely with the intention of probing exactly what it is expected the Secretary of State's guidance might say.
The Bill appears to be moving dangerously in the direction of government interference. Initially, it gives the Mayor the power to direct a citywide strategy.
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Baroness Morgan of Drefelin: As we have just heard, Amendment No. 57removes the duty on the Mayor to have regard to any guidance from the Secretary of State about the matters to take into account when preparing or revising the strategy.
Secretary of State guidance is a standard requirement across all statutory strategies in the 1999 Act, so it would be inconsistent to remove the requirement in relation to the health inequalities strategy. The duty on the Mayor to have regard to such guidance gives the Secretary of State the opportunity to provide early input to the strategy where appropriate. I hope that the noble Baroness will feel able to withdraw her amendment.
Baroness Hanham: I hear what the Minister says and I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
[Amendments Nos. 58 and 59 not moved.]
Baroness Andrews moved Amendment No. 60:
On Question, amendment agreed to.
[Amendments Nos. 61 to 67 not moved.]
Clause 22, as amended, agreed to.
Baroness Andrews: This may be a convenient time for the Committee to adjourn until next Tuesday at 3.30 pm.
The Committee adjourned at 7.45 pm.
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