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Lord Harris of Haringey: A great deal of effort is being made in relation to public health in London. I am aware that the new London NHS region is devoting a considerable amount of effort to developing a public health strategy and doing so in conjunction with all the relevant stakeholders, including local government and the voluntary sector. That is extremely welcome.

However, given the responsibilities placed on the mayor to look closely at public health indicators and to ensure that in developing strategies public health is kept in mind, it is extremely likely that the mayor will want to take an overview of the public health of the people of Greater London and of the policies which the Government and other agencies are following.

It is also inevitable that the mayor will produce something like a report on the state of public health. Given that the work is being done within the NHS region, would it not be better for that report to be published under the name of the mayor, which would give it a great deal more prominence and ensure that other agencies focus attention on its implications?

I have a great deal of sympathy with what the noble Lord, Lord Clement-Jones, proposed in his amendment because it corresponds to what is likely to happen and will give a considerable boost to this area of the mayor's work and responsibilities.

6.45 p.m.

Baroness Farrington of Ribbleton: The noble Lord's amendment would require the mayor to publish a state of public health report three years after the first ordinary election and subsequently every four years. We believe that it would be wrong to impose such a requirement on the authority. The GLA will have no responsibilities for the provision of health services in Greater London. It will not be responsible for the state

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of health of Londoners. People's good or bad health depends upon a wide range of factors, including what they do to themselves.

However, the GLA will be under a duty, both in the exercise of its powers and the preparation of its strategies, to consider their effect on the health of people in London and to promote improvements in their health. The mayor will therefore be instrumental in seeking to effect improvements in public health. We have no doubt that both the mayor and the assembly will take an intense interest in what can and should be done to improve public health in London; and an equally intense interest in the quality and reliability of the provision of health services. Undoubtedly, they will produce reports of both a general and specific nature about the health of Londoners.

However, the monitoring of public health and the provision of public health services will not be their responsibility. The London executive of the NHS, the health authorities and other bodies will do that. We do, of course, expect there to be close liaison and co-operation between the GLA and the responsible health authorities and bodies. I hope that the noble Lord will accept that in the circumstances it would be wrong and inappropriate to require the mayor to produce a specific report and that he will agree to withdraw his amendment.

Baroness Hamwee: We are well aware of that and did not intend the measure to be about the provision of health services. We tabled the amendment because of the mayor's duties and responsibilities, in particular social development and the environment. We believe that the state of public health is closely related to those two issues.

I believe that a report would be a necessary basis to allow those scrutinising draft strategies to test whether the strategies proposed are correct. I regard this provision, or something similar, as necessary in order to ensure that the constituent parts of the authority--the mayor and the assembly--are able to do their jobs properly.

Lord Clement-Jones: First, I thank the noble Lord, Lord Harris of Haringey, for his support on the amendment. I know that it will carry considerable weight in London health circles. We tabled the amendment as a step back from requiring the authority to produce a full health strategy. We feel strongly that there is a good case for that. But, given that that is not possible, there are other ways of producing a health strategy. It is essential to have a state of public health support which pulls together progress being made by the different agencies and authorities in London. Who better than the mayor and the authority to do that pulling together, to demonstrate that leadership? It is not about the delivery of health services, as my noble friend Lady Hamwee made clear. It is about the indicators and other aspects of the other strategies pursued by the mayor that have an impact on public health in London.

In many respects the health service plays a fairly limited part in ironing out health inequalities. Housing and education probably form a more important part in

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ironing out health inequalities than the health service, which often deals with acute health as opposed to prevention or promotion of good health.

I do not believe that it is wrong to require the mayor to produce such a report. The duty being imposed--once every four years--is not an onerous one. I do not believe that an authority faced with a requirement to produce a report once every four years will find that unduly onerous. We hope that there will be a centre of excellence on public health matters, whether in the regional health authorities or in the authority itself, and that there will be a unit that concentrates on and has expertise in public health matters in Greater London. Wherever it is placed, it will help to produce that report. However, it is important that the report is produced and we believe that the best place to produce it is the GLA. Clearly, we shall not press the matter in Committee, but we may want to return to it on Report.

Baroness Farrington of Ribbleton: Is the noble Lord, Lord Clement-Jones, saying that he would envisage the mayor being able to require people working for the health service in London to work for him in producing the report? I was unclear whether he was saying that the centre of excellence could be required to work with the mayor were the health authority not to consider that. Of course, the mayor, working in co-operation with the London health service executive and others, will have information necessary to produce the mayor's strategies. The service executive would not have to produce its own reports. It would want to monitor and assess the effect of the different strategies on health.

Lord Clement-Jones: I thank the Minister for that additional response. I am not sure that I am clear about what the Minister is trying to say. There is a duty of co-operation and partnership under the new Health Bill, which, in a sense, should meet such matters. Of course, if the NHS region has information, it should be able to provide that to the GLA, if the GLA has the responsibility for drawing up the state of the public health report. It would not be a question of executive responsibility for a public health unit, but if it were felt appropriate that the mayor should have his or her own public health unit in order to assess health--there is a duty under Clause 25, I believe, about carrying out the mayor's duties under Clause 33--there may well be a need for health expertise within the GLA itself.

With the greatest respect, I believe it is a slight red herring to worry at this stage about where the expertise will be, and who will have control over that expertise. With the right partnership between the different agencies and authorities, which will be essential in drawing up other strategies across the board in London, it should be entirely possible once every four years--I emphasise that--to draw up a state of the public health report.

I urge the Government to think again because this is a matter that has considerable support and takes things a notch further than the health assessment inserted by the Government in the other place. In the meantime, I beg leave to withdraw the amendment.

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Amendment, by leave, withdrawn.

Baroness Hamwee moved Amendment No. 142:

Page 22, line 24, after ("year") insert ("and at least ten working days before the debate to be held under section 39 below").

The noble Baroness said: Clause 38 provides for the preparation by the mayor of an annual report and Clause 39 provides for an annual debate. I tabled my amendment to suggest that in addition to the mayor being obliged to produce it,

    "As soon as practicable after the end of each financial year", the mayor is under an obligation to ensure that the report is available in good time before the annual debate. Therefore, I suggest that it is available at least 10 working days before that debate--in other words two weeks. I believe that that is the minimum period one should expect, although one would hope that it would be available considerably earlier.

I realise that in drafting the amendment I should have made a similar amendment to line 39. Nevertheless, this amendment enables me to raise the general point. I beg to move.

Lord Whitty: On this amendment we are arguing whether the report should be available in 10 working days or seven working days. Either provision is substantially better than we generally have in this House or the other place when discussing major reports from any government of any complexion. It is important that, as soon as the report is available, it is subject to immediate scrutiny and immediate debate. Seven days seems an adequate period for the full time assembly members and for most organisations within London to have considered it. I see no great advantage in extending the period to 10 days. I believe that a period of seven days gives enough time for interested parties to digest the report and it is not too long before the debate is held. Therefore, I am not convinced that that change is necessary.

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