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Lord Bowness: My Lords, I oppose the amendment, conscious that I follow a noble Lord who has considerable expertise in health matters. I do not oppose the amendment because health is not proposed to be within the jurisdiction of the mayor or the
If the mayor of London is dissatisfied with the state of public health within Greater London or its provision, I have no doubt that he or she will comment. It would be an extraordinary political figure, elected with the kind of mandate that we hope that the mayor will have, if he or she did not comment with that kind of authority.
Already there is a plethora of reports on health issues from trusts and authorities within London. Although health is not a function of London boroughs, many such boroughs examine the trends on health in their own areas and produce their own reports. No doubt if the mayor wants to produce a report, he will pull together all the information and publish such a report. As has already been pointed out, he is obliged to monitor the progress of his strategies, including the impact that they have on public health. He will look to the information that is available.
This Bill is already long on reports and strategies. They are a big feature of this legislation and I have no doubt that more reports and strategies will be produced by the mayor of the greater London authority than this legislation requires. The temptation to produce a glossy" on almost anything will not be resisted, I am sure. I do not believe that we want another statutory requirement for another report on another subject, however worthy that subject may be.
As has been said, the amendment is not about service delivery and is not, therefore, about staffing up"--to use the terminology of the noble Lord, Lord Bowness--in quite the way the noble Lord's criticism may have suggested. It is not only arguable, but I believe accepted, including by those who oppose the amendment, that the London authority will have an enormous influence on the state of public health in London.
I became aware of the GLA's role--not through the report to which the noble Lord referred, but through a debate organised by the King's Fund--when that view was expressed extremely forcefully. One only needs to think of a few of the GLA's primary functions--for example, regeneration, which must be about tackling poverty; transport, which includes the effect on air quality and the stress levels suffered by Londoners; as well as looking at the principal purposes as expressed
Clause 25, subsections (4) and (5), contain a duty, in exercising the powers, to have regard to the effect on health and how the powers can best be calculated to promote the improvement of health. In other words, the Government recognise the scope and the opportunities of what they are proposing for London.
The mayor will need information about public health in order to feed it into the other strategies to enable him to carry out his or her obligations with regard to those strategies from the point of view of health. Conversely, the mayor has a duty to be seen to be taking the lead and helping to co-ordinate the approach to these issues. That is not the same as delivering health services but it is a reflection of the mayor's duties.
We talked earlier today about monitoring, and a strategy group would be helpful in monitoring the effect of what the mayor is doing in this area and the implications for public health of other actions. Perhaps I may put one specific question to the Minister: if the Government are not minded to accept these amendment and the provisions do not find their way, in this or a similar form, into the Bill, can the Minister confirm that there is nothing in the Bill to stop the mayor from organising the sort of report which is the subject of this amendment and obtaining advice in the way proposed? In other words, the optional extras that the mayor will undertake can cover the areas to which the amendments are addressed.
Baroness Farrington of Ribbleton: My Lords, it may be helpful for me to begin by confirming to the noble Baroness, Lady Hamwee, that there is nothing in the Bill to prevent the mayor or the assembly from appointing a public health specialist or specialists to the staff of the GLA or having advisory groups. That perhaps also partly answers my noble friend Lord Rea.
These amendments are similar to those tabled by the noble Baroness at Committee stage. They require the mayor to publish a report on the state of public health in London, and to provide for a health strategy group for London to advise the mayor in preparing the report. The group would also advise the mayor on the content of his or her state of the environment report, air quality and ambient noise strategies; matters relating to his powers to promote social development and improvements to the health of Londoners; and the effect of his strategies on the health of Londoners.
The Bill as drafted ensures that health and public health considerations will be a priority of the mayor in discharging his or her two most important functions--the preparation of strategies and the exercise of the general power. For example, in deciding whether or not to exercise the authority's general power, the mayor must have regard to the effect that the proposed exercise of the power would have on the health of
Similarly, in relation to strategies--this answers a further point raised by the noble Baroness, Lady Hamwee--the mayor must have regard to the effect which a proposed strategy or the revision of a strategy would have on the health of persons in Greater London. In addition, where the mayor prepares or revises any strategy, he must include such available policies and proposals relating to the subject matter of the strategy as he considers best calculated to promote improvements in the health of persons in Greater London.
The framework we have put in place is designed to ensure that the improvement of the health of Londoners is a primary concern of the mayor, both in the exercise of the general power and in the formulation of policies and strategies. Each of these strategies must be consistent with one another, and we shall accordingly achieve an integrated approach to health matters.
We cannot, therefore, accept the case for a separate health strategy. The promotion of health improvements will be taken into account in the exercise of key mayoral functions. But, as the mayor will have no executive responsibilities in respect of health services, and major health service providers in London will be outside the remit of the authority, it would be misleading to allow a separate health strategy to be produced. Similarly, we see no need for a requirement to set up a health strategy group to assist in the carrying out of that function, or the other functions set out in the amendment.
In response to the question raised by my noble friend Lord Rea, the boundaries would not be co-terminous--in my experience in public life, the answer is always that the boundaries would not be co-terminous. The mayor could, of course, publish a health strategy if he chose to do so, and could also convene an advisory group of health experts if he thought that was appropriate. But these are properly matters for the mayor to decide, and it is not appropriate to require him or her to prepare a separate, discrete health strategy.
Under the provisions of Clause 38 of the Bill, the mayor must produce an annual report which must include an assessment of his or her progress in implementing the strategies the Bill requires to be prepared and published. We agree with the noble Lord, Lord Bowness, that the production of such a report will include information about the impact on, and improvement to, the health of Londoners that these strategies will have. We therefore ask the noble Lord to withdraw the amendment.
Lord Clement-Jones: My Lords, I thank the noble Baroness for her reply. Before I discuss the terms of her reply and in response to the noble Lord, Lord Bowness, perhaps I may say that I fully understand the desire not to increase the bureaucracy
We are not proposing a separate health strategy. We on these Benches are very environmental. I suspect that part of the Minister's speech was a little bit recycled from the Committee stage in terms of talking about a health strategy. We have not proposed a health strategy for London in this group of amendments. We made that proposal in Committee; this is a separate proposal. It is about producing a report on the state of public health in London and measuring the indicators to determine whether progress is being made. It is not about a health strategy. The noble Baroness said that it was inappropriate that a health strategy should be set up.
I thank the noble Lord, Lord Rea, in particular, for his valuable expertise on this subject; it was very useful. I wholeheartedly agree with his comments that this would fulfil in full the recommendations of the King's Fund. It would take it that one step further to ensure that action on public health was fully effective in all the fields that it needs to be--not only in the pure area of NHS health but also in the areas of the mayor's strategies, such as transport, waste, the environment and so on.
Returning to the Minister's remarks, it seems extraordinary that, despite the fact that she said the mayor could, on a voluntary basis, produce a report and set up an advisory committee--all those things are possible--she is resistant to enshrining them in the Bill. It seems far preferable to have a clear mechanism for setting up these two matters, rather than relying on something established on a voluntary basis. At some future date the mayor could be in negotiation with other bodies without the necessary standing that he or she will need if the mayor and the GLA are to be effective in the area of health. If the Government are genuine in saying that health will form a major consideration--I think the Minister said a primary concern"--surely the setting up of both a statutory advisory group and a regular progress report are vital to ensure that that primary concern is met.
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