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Lord Dixon-Smith: My Lords, I cannot be surprised at the tone of the Minister's response. He says, in effect, “This is good, right and proper. It will happen but we cannot put it on the face of the Bill." That may be all right. I take his remarks as being a pledge that this will happen. If that is the case, we are entirely used to accepting that that will be so. I suppose I shall have to be satisfied with that. I do not believe that the question of what was or was not in the Scotland Bill is relevant. I am bound to say that whether parliamentary Acts are published on vellum or archive paper is also not relevant to this argument. I do not see why an authority such as the GLA should not lead the way, even for the mother of parliaments, dare one say? In the light of the remarks made by the Minister, it may well be that that happens. I hope it does. In the mean time, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

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4.45 p.m.

Clause 36 [Directions by the Secretary of State]:

Lord Clement-Jones moved Amendment No. 131:


After Clause 36, insert the following new clause--

LONDON PUBLIC HEALTH REPORT

(“ .--(1) The Mayor shall prepare and publish a document to be known for the purposes of this Act as the London public health report.
(2) The London public health report shall contain--
(a) information about the state of public health in Greater London;
(b) an assessment of the impact of the Mayor's strategies specified in section 33(1) above on the state of public health in Greater London;
(c) information about the measures which other persons or bodies are to be encouraged by the Mayor to take for the purpose of improving the health of persons in Greater London;
(d) information about the measures which other persons or bodies have encouraged the Mayor to take for the purpose of improving the health of persons in Greater London.
(3) The London public health report shall be published--
(a) in the case of the first London public health report, before the end of the period of three years beginning with the day of the first ordinary election;
(b) in the case of each London public health report subsequent to the first, before the end of the period of four years beginning with the day on which the previous state of the public health report was published.").

The noble Lord said: My Lords, the current provisions regarding the health of people in Greater London are contained in Clauses 23 and 25 of the Bill. The latter places a duty on the authority to carry out a health impact assessment in the exercise of its powers. The former provides a duty on the mayor to promote improvements in health when considering the various strategies adopted by the GLA. However, in our view those clauses do not go far enough.

In Committee, the noble Baroness, Lady Farrington of Ribbleton, stated that the effect of these existing provisions is that health considerations will be a top priority for the mayor in discharging his or her two most important functions: the preparation of strategies and the exercise of the general power.

With the greatest respect, it is difficult to read the Bill in that way. Her argument against going any further, whether in respect of instituting a health strategy or a public health report, was that as the mayor will have no responsibilities in respect of health services and major health service providers in London will be outside the remit of the authority, it would be respectively misleading or wrong and inappropriate to require a separate health strategy or a public health report to be produced.

Frequently, public health has been confirmed as central to the strategies of the Government. London has particular public health issues. In London detentions under the Mental Health Act are almost twice as high as the national average. A study published since the Committee stage of this Bill has shown that although some health indicators such as

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childhood mortality are good, others such as deaths from ischaemic heart disease and respiratory disease are unacceptably high. Similarly, teenage pregnancies and abortions are exceptionally high in London. Some 13 of the 20 most deprived boroughs in England are in London, with all that that implies for the health of the people living in those areas.

Last year, in his report, Sir Donald Acheson made it clear that health inequalities are linked to conditions in a wide variety of other areas such as housing, education, planning, transport and the environment. We believe that if the mayor does not have a general overview at regional level of the state of public health, we cannot expect London's considerable health inequalities in those areas to be tackled.

Amendment No. 131 is framed in similar terms to the duty to report on the state of the environment in Greater London, as now set out in Clause 309. The amendment is designed to ensure that the mayor regularly takes stock of the state of public health, publishes key indicators in order to measure progress and states the impact of policy actions taken to date.

Information on the health of those who live in London needs to be drawn together for the benefit of Londoners and for the benefit of the other strategies to be developed by the mayor. Such a report would fulfil that.

Amendment No. 545 is complementary to Amendment No. 131. It provides for a mayor's strategy group on public health to be set up and a function of that group would be to provide advice to the mayor on the contents of the London public health report. Now that a single NHS region covers London, it is essential that there is an advisory group for health that can contribute to mayoral strategies in areas other than health as well as on the state of public health.

Without a strategy group and a regular report on London as a whole, the task of achieving a healthier London population will be made immeasurably more difficult. If government in London genuinely is to be joined up at a regional level, it is essential to have a clear duty to report on the state of public health and to have a health strategy group. Having had the summer weeks to reconsider this matter, I hope that the Minister will accept the merit of such arguments.

In Committee we also argued for a health strategy. That is a less radical step, but as the noble Lord, Lord Harris of Haringey--I am sorry not to see him in his place today--said in Committee:


    “it corresponds to what is likely to happen and will give a considerable boost to this area of the mayor's work and responsibilities".--[Official Report, 23/6/99; col. 978.]

I very much agree with that. I look forward to hearing what the Minister has to say. I beg to move.

Lord Rea: My Lords, during the whole of my professional life I have been in the business of prescribing. I believe that the prescription contained in this amendment is not too prescriptive. I believe that it will do the patients--the citizens of London--a great deal of good.

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In supporting the amendment tabled by the noble Lord, Lord Clement-Jones, I emphasise that both the report on public health and the health strategy group proposed in the two amendments will not be concerned with providing health services. They will be the sole responsibility of the National Health Service, co-ordinated by the London regional office of the National Health Service, which I understand--if I am wrong perhaps my noble friend will correct me--will be coterminous with the area covered by the GLA.

As my noble friend knows, the health of the population, particularly of those living in cities, and the consequent burden of the ill-health of the population on the National Health Service, depend to a large extent on factors totally outside the control of a national health service, such as housing, employment, opportunities for exercise, food quality and education, to name only a few. In all those areas the Greater London Authority and the mayor will have great opportunities to make a real difference. The suggested public health report will inform the mayor and the London regional office of the National Health Service of the health needs of Londoners and suggest ways of improving them and that will lie outside the remit of a national health service.

Clause 33 requires the mayor to bear in mind the health impact of his policies, as mentioned by the noble Lord. I am glad of that. If the mayor does not have a public health team to produce the public health report, as suggested in the amendment, and to draw up the strategy required by Amendment No. 545, how will he be able to measure accurately the health impact of his policies? Without a team of public health experts, which need not be very large, the health impact assessment that he is required to make is likely to be marginalised and expressed in general terms.

To describe health impacts one needs to use the expertise of epidemiologists. Such people could make up the group that would draw up the report and the strategy.

An important study by the King's Fund, called Health & the London Mayor, strongly argues for a duty of partnership between the Greater London Authority and the regional office of the National Health Service and that there should be a public health team in the secretariat, headed by a full-time director, whose remit would include liaison with the regional office of the NHS. The arrangements proposed in the two amendments would fulfil that recommendation.

I do not believe that that report by the King's Fund was given adequate consideration when the Bill went through another place. If my noble friend cannot accept these amendments today, I hope that after discussions, which we could arrange, and a full perusal of the King's Fund report, she may return at Third Reading with her own amendments incorporating some of our suggestions.


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