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Health and Social Care Bill

As the noble Earl said, we now turn to Part 3. Clause 123 updates the Public Health (Control of Disease Act) 1984. It builds on local authorities’ existing powers to protect the public from significant health risks while introducing safeguards to protect the individual. For example, the existing legislation only provides a justice of the peace with the power to require an individual to be medically examined, to remove an individual to hospital or to require that he is detained in hospital. We believe that those are extreme measures, and the new legislation offers a flexible range of measures enabling the justice of the peace to seek the most appropriate measure for the case—in many cases, a much less restrictive option than the previous Act would have allowed. I apologise for the density and diversity of these clauses. I sought assurance from my officials that it was necessary for them to be written in this way, and I was assured that it was necessary in order to cover all the eventualities and safeguards. Amendment No. 161 removes new Section 45C(2)(b), which clarifies some of the ways in which the domestic regulation-making power may be used. The scope of this power needs to be broad in order to ensure that we can take action to protect public health. However, I recognise that it can raise legitimate concerns, which is why we have set out in the delegated powers memorandum and the further detailed policy statement how we intend to use it. Those detailed explanations of our intent are available in the Library, and I have placed copies in the corner of this Room. In addressing some of the other amendments laid against new Section 45C, I hope to be able to persuade the noble Earl and the noble Baronesses why the provision is necessary. Amendment No. 162 seeks to ensure that, when regulations are made under Section 45C(3)(c) to impose or enable the imposition of restrictions or requirements on or in relation to a person, thing or premises, it is done in response to a demonstrably significant threat to public health. I hope that noble Lords will be reassured to know that there are already safeguards in the Bill to ensure that new Section 45C is used in the right circumstances. The Bill already ensures that all domestic health protection regulations must be in relation to an infection or contamination that poses significant harm to human health. The judgment that Amendment No. 162 asks us to make is whether the infection that can cause significant harm to a human’s health is also one that could cause a wider public health threat. That may not be possible where the threat is new and the science is not yet available to assess its significance. For example, when SARS first emerged, there was little scientific evidence about how it was transmitted. It was clear that it was a danger to humans who were infected, but it was unclear how great the risk was to the public at large. Amendment No. 162 would require the degree of risk to be known before regulations could be made, and that could disempower Ministers putting in place precautionary or contingent measures that could save lives. I turn to Amendment No. 166. The noble Baroness, Lady Stern, suggests that the existing provisions do not make it crystal clear that, while regulations cannot impose a special restriction or requirement for medical examination, detention, isolation or quarantine, they can enable the imposition of these requirements. I sympathise with that point. When drafting the provisions, it was not the intention to hide the fact that the regulations could enable the imposition of those measures in certain circumstances. To put this issue beyond doubt, let me state for the record that the regulations are intended to allow the imposition of medical examination, detention, quarantine or isolation when a decision-maker determines that such a measure is a proportionate response to a serious and imminent threat to public health. Furthermore, let me clarify that the decision-maker, who would be specified in regulations, would be the Secretary of State or Welsh Ministers, where that would be appropriate. Amendment No. 166A seeks to remove the power of the Secretary of State or Welsh Ministers to confer functions through the international travel and domestic regulation-making power on persons other than the local authority. I shall explain how the power, which can be found at Section 45F(2)(a) of Part 3, could be used. During an incident similar to the SARS outbreak in 2002-03, this provision would allow the Secretary of State to enable doctors to make decisions about whether a patient should be quarantined. On a more day-to-day level, the provision would enable port health authorities to carry out the function of inspecting ships and awarding ship sanitation certificates, which is a requirement under the International Health Regulations 2005. I am sure that noble Lords will see why the provision is necessary. Amendment No. 167 seeks to restrict the length of time that regulations directly imposing any of the ““special restrictions or requirements”” on people, things or premises can remain in force. It would require regulations containing such measures to lapse after six months. That might, in some cases, be appropriate for a measure involving a significant impact on a person’s private life. However, new Section 45C(3) allows regulations to be made imposing from the centre a ““special restriction and requirement”” to, for example, a category of premises. This could be quite a routine matter, needing to remain in force for a long time—for example, requiring all premises of a particular type to be regularly disinfected in a particular way. It would not be appropriate to take up Parliament’s time in having to remake such arrangements every six months. The second part of Amendment No. 167 would insert a new subsection (5B), which seeks to impose time restrictions of 14 days where the regulations enable the imposition of detention, quarantine or isolation by a designated decision-maker in the face of a ““serious and imminent”” threat. Fourteen days is half the quarantine period of some serious infectious diseases. For example, Hantavirus, a viral haemorrhagic fever spread by rodents, has an incubation period of two to four weeks and can be fatal. As for how the legislation overlaps with the Civil Contingencies Act, the Bill will allow us to bridge the gap between voluntary compliance with public health measures and the use of more extreme civil contingency powers. The new provisions provide a set of powers specifically tailored for dealing with a significant threat to public health. They introduce specific safeguards and set out the type of provisions that might be made. Unlike the Civil Contingencies Act, regulations under the domestic regulation-making power can be made in advance of a serious and imminent situation so that they are in place as soon as it becomes necessary to invoke them. This gives organisations involved a clear understanding of what measures might be put in place when needed. The domestic regulation-making power also enables the Secretary of State to make regulations placing restrictions and requirements on individuals, things and premises before a threat becomes serious or widespread in order to prevent an emergency occurring. At the other end of the scale, these powers enable routine good housekeeping, such as systems for notifying specific cases of infection or contamination, which is quite outside the scope of the Civil Contingencies Act. The noble Earl asked for some examples of the type of restrictions and requirements that the Secretary of State might impose and why. I have three examples. First, if a contaminated cargo was dispersed across the country, the powers would enable the Secretary of State to recall the cargo and require local authorities to track down those who had contact with the cargo and offer them medical advice. In my second example, if human-to-human transfer of avian flu became a greater likelihood, the Secretary of State might consider it a proportionate reaction to require all individuals working with poultry to wear protective clothing and undertake a decontamination regime at the end of their daily shift. This could reduce the spread of any infection to family and friends. Finally, if there was a large outbreak of SARS, the regulations could be used to empower hospitals to require all visitors to SARS patients to wear protective clothing to reduce the risk of onward spread.