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Public Health

My Lords, I am grateful to the noble Baroness for the welcome she has given to at least certain elements of the White Paper, and I join her in expressing the hope that this is an area where we can work across the parties. That is because, as the White Paper says, this is very much a matter for all citizens and all elements in society, including industry and employers as well as parliamentarians. However, she asked a number of questions and made several criticisms, so I shall endeavour to reply to as many as I can. The noble Baroness started by saying that she feels that the White Paper is a little short on strategy. I do not share that view. It makes it clear that we are making a conscious shift of power to local government to draw together public health with the factors that are so influential in achieving good health outcomes. Examples of those factors are housing, transport and education. It is about simplifying, strengthening and unifying national arrangements to reduce red tape and duplication, and to have a clear focus and high priority on public health within central government as well. I believe that the strategy is clear and I hope that, when she has had time to read the White Paper at leisure, she will modify her view. She referred to the Health Protection Agency and she was right to say that the functions of the agency are, if Parliament agrees, going to be subsumed into Public Health England. The new body will bring together key professionals involved in public health from the national to the local level. It will have a mission to protect and help improve the nation’s health and well-being. She asked about directors of public health in the new system. With the abolition of primary care trusts, directors of public health, employed by local authorities but jointly appointed with Public Health England, will be responsible for commissioning health improvement and some health protection services using the ring-fenced budget to which I referred. We envisage that, through local partnership working, including through the local health and well-being board, directors of public health will be able to influence the wider determinants of health and well-being and improve outcomes for their local population. The noble Baroness was sceptical about the concept of ““nudge””. The Government’s approach to health improvement is not based solely on nudging people. We accept that the evidence base for applying insights from behavioural science and health contexts is relatively undeveloped. That means that we need to develop the evidence base for that approach, clearly, and that we need to use a wide variety of methods to encourage people to adopt healthier behaviours, not just based on nudges but by continuing to use other effective approaches, such as customer insight and segmentation. As the Statement mentioned, there will always be a role for regulation. However, the Nuffield ladder, which the noble Baroness will see in the White Paper, gives a very good illustration of the menu of options available to us in this context. The noble Baroness referred to schools, and I note her concerns. At the same time, we have plans for developing the use of school nurses. I see that as a very important part of the vision to ensure that we can have a workforce that is alive to public health issues in the school context. A great deal of work is going on, and I would be happy to brief the noble Baroness on that. She referred to tobacco, an issue to which we regularly return. I have little, I fear, to add to what I told the House during the Question earlier this afternoon. However, we are considering plain packaging, as I mentioned earlier. The current intention is to ask retailers to cover up their displays of cigarettes so that children are not attracted by the packaging. This is widely accepted as the last form of marketing available to tobacco companies to recruit new smokers. We also want to look at how plain packaging could further protect children from taking up smoking in the first place, and help support people who are trying to quit. It is early days. We cannot say more than that at the moment, but it is something to which I am sure that we can return. On tobacco displays, I cannot add to what I told the House earlier this afternoon. This is still under consideration. I am glad that the noble Baroness welcomed the concept of the ring-fenced budget. Local authorities will be accountable for the use of the budget. We expect that directors of public health will take the lead in local authorities on the use of the budget. We will be clear about the outcomes that we are seeking, but we will not be prescriptive about how those outcomes are achieved. I think that there will be transparency about the use of the budget through the normal, local, democratic means. More details on the accountability arrangements will be set out in the public health funding and commissioning consultation document, which will be published very shortly. Finally, the noble Baroness asked me to clarify how we viewed the system as being joined up. We do, I think, view this as potentially a joined-up system. Successful delivery of public health services will require strong links not only from Public Health England at the centre with local authorities, but also between local authorities and the NHS. Joint working will be essential in supporting the collection and provision of the information needed to inform future commissioning, and to enable specific public health services to be commissioned through and delivered by the NHS. That will require a sharing of expertise and knowledge across the two services. I look forward, as I hope the noble Baroness does, to a new public health effort. We will doubtless return to this topic when, in due course, the health and social care Bill reaches this House as there are important measures in it on which this service will depend.