New Clause 44 - Directors of public health

Part of Health and Care Bill – in a Public Bill Committee at 2:00 pm on 28 October 2021.

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Photo of Edward Argar Edward Argar Minister of State (Department of Health and Social Care) 2:00, 28 October 2021

It is a pleasure to see you in the Chair once again, Ms Elliott.

My understanding, in the light of what the shadow Minister has said, is that one of the underlying aims of the new clause is to ensure that the public’s health is at the fore as we reform the health and care system. I have the utmost sympathy with that an aim

The Government recognise the importance of a robust public health system that works to improve the health and wellbeing of the nation and to prevent disease. That is why we have taken decisive steps to reshape our national public health bodies so that we are well equipped to face future challenges. Furthermore, we agree that directors of public health and their teams should have a crucial role at the heart of the new system.

The shadow Minister is absolutely right to say that although directors of public health are hosted by local authorities, they represent the whole system, and we owe them a debt of gratitude. In our past lives, he and I would have worked with DPHs in our local authority contexts, and of course, as Members of Parliament, we have all seen what our local DPHs have had to do over the past year and a half. I suspect that Members who did not know their local DPH have probably got to know them and their work in the community a lot better, which is no bad thing.

This fits naturally with the strategic emphasis on population health that we expect of integrated care systems. Both the Department of Health and Social Care and NHS England have set out in published policy and guidance documents our expectation of directors of public health having an “official role” in integrated care systems. Officials in the Department are working closely with the Association of Directors of Public Health and others to help describe further the place of these roles, the outcomes that we hope collectively to achieve, and the ways in which they can best add value to the system’s impact on health overall.

Although we entirely understand the motivation behind the new clause, I am not sure that it is strictly necessary. It seeks to clarify the roles, powers and duties of DPHs, but their roles and responsibilities are already clearly and accurately set out in legislation and current guidance. The requirement for the recruitment to the role of director of public health, for example, is already clear on professional qualifications, and the registration and regulation requirements are clearly laid out. The new clause may have the effect of reducing the flexibility of the post, although I am sure that the shadow Minister would say that that concern is unfounded.

Furthermore, the current system already provides independence and influence for directors of public health, and that is strengthened by several provisions in the Bill, which includes, for instance, a duty on ICBs to seek advice from persons with the appropriate expertise on prevention and public health, including directors of public health, complementing the existing duty, in the section 6C regulations of the National Health Service Act 2006, for local authorities to provide the NHS with public health advice.

Additionally, we do not believe it necessary to make directors of public health officers of the NHS, as the Bill already provides opportunities for DPHs to link into and influence NHS bodies in their current guise. Integrated care partnerships, for instance, must develop an integrated care strategy to which integrated care boards must have regard in drawing up their commissioning plans. The intended result is to create a plan to meet the health—including public health—and social care needs of the population within their defined geography. That will provide directors of public health with the opportunity to influence NHS commissioning plans to meet wider public health aims.

It is also possible that the new clause would create a number of undesirable consequences—I suspect that the shadow Minister will allay some of those fears in his response. Rather than bringing clarity, the new clause could create confusion and complexity in a system that is already functioning effectively with a clear understanding of the role and how it operates.

The new clause would put a host of prescriptive new requirements on DPHs, including a requirement for them to be officers of the NHS, NHS consultants in public health, and officers of the Crown, while retaining independence of thought and action.

While we certainly understand the motivation of wanting to knit together the system through an individual post, that approach would add a layer of complexity. I believe that it would be challenging for an individual holding that office to seek to balance those complex responsibilities, accountabilities and potentially competing priorities within various organisations. That would also complicate the lines of accountability

My concern is that the new clause is overly prescriptive about the status and nature of the role, which would go against the overall aims of the Bill in terms of permissiveness. Although we hope and expect that directors of public health will act as a nexus for bringing coherence to the local system’s focus on population health, we are not convinced that this level of prescription over permissiveness is appropriate. That reflects a thread of the debate throughout the passage of the legislation on where the appropriate balance should be struck.

Proposed new paragraphs (e) and (h) would weaken the ties that directors of public health have with local authorities. Since the 2012 reforms, there has been widespread consensus that local authorities are best equipped to deal with a wider range of public health matters for their population’s needs. In that context, I pay tribute to local authorities for their role in tackling the pandemic, including those in elected roles. If I recall correctly, the wife and partner of the shadow Minister, the hon. Member for Ellesmere Port and Neston, is active as an elected councillor in a local authority. Many Members of this House will have served in that role, too, and will recognise what local authority councillors and officers do in that space.

From their home in local government, DPHs have been able to maintain an independent mindset while playing a critical role in improving and protecting the public’s health. Although it may well evolve in future, that system is working, and we have a strong and solid base that is understood by all system players. I therefore encourage the shadow Minister to continue to work with me and others to make that system work, rather than seeking to press the new clause to a Division.