Levelling Up Bill: Bishop of Carlisle speaks on health inqualities

The House of Lords debated the Levelling Up Bill in its second reading on 17th January 2023. The Bishop of Carlisle spoke in the debate, focusing on health inequalities between the North and South of England:

The Lord Bishop of Carlisle: My Lords, in the brief time available, I will address health inequalities between the north of England, where I live, and the south, and their implications for levelling up and regeneration. Health inequalities are defined as avoidable, unfair and systematic differences in health between different groups of people. In 2010, Sir Michael Marmot conducted his celebrated review into such inequalities, in the hope that this might lead to some improvement. Instead, we have seen an increase, rather than a reduction, of such inequalities over the last 12 years. For instance, life expectancy in deprived areas of the north-east is at least five years lower than it is in similar areas here in London. A baby boy born in Blackpool today can expect an additional 17 years of poor health compared with a baby born in Richmond upon Thames. People in all social groups in the north of England, male and female, are consistently less healthy than those in the south, and premature death rates are about 20% higher across all age groups in the north, due not least to lower lifetime chances.

These statistics—there are many more—are a stark reminder that inequalities in health are often closely linked to people’s socioeconomic circumstances. This has been forcefully illustrated by the Covid pandemic, which, in the words of one commentator, exposed “deep fractures of inequality” running across our society. During the first year of the pandemic, the mortality rate was 17% higher in the north than in the south, unemployment was 19% higher and there were significant differences in mental well-being between the north and the south. It is now reckoned that health issues account for about 30% of the gap in productivity between the north and the south.

Reducing health inequalities is a matter of fairness and social justice, which is what the Levelling-up and Regeneration Bill is all about. It potentially provides us with a great opportunity to tackle those inequalities, not least by addressing some of their wider social determinants, two of which have already been mentioned by several noble Lords in this debate: transport and housing. Transport, especially in rural areas, has huge implications for access to hospitals and medical services. I recently had some post-operative treatment in the excellent general hospital in Hexham, and, while I was there, I took the opportunity to ask several of the staff what they would most like to see change. “Access” was their unanimous answer, and this is especially true in a huge, sparsely populated county such as Cumbria, which has neither big cities nor many large hospitals.

On housing, which was mentioned by so many speakers, we are all aware of the close connection, which the noble Baroness, Lady Warwick, reminded us of, between good-quality accommodation and good physical and mental health. The briefing from Shelter that I guess we all received comes as a timely reminder of the need for much more social housing in the north —not just, as the noble Baroness, Lady Thornhill, said, so-called “affordable housing” in expensive areas.

Alongside paying attention to transport and housing, any effective strategy for reducing these health inequalities must include a commitment to two other factors. One is community hospitals, of which we have a number in the county where I live. These not only prevent admission to acute units but enable earlier discharge from larger hospitals. They are an invaluable local resource, but many are losing beds and are starved of funds. The other is better integration between health and social care. I hope that the new structures—ICBs and so on —will make a real difference. I hope also that continuing work on levelling up and regeneration will be properly informed and influenced by two forthcoming reports on social care, from a Select Committee of your Lordships’ House and from an Archbishops’ commission.

This Bill commits His Majesty’s Government to putting forward a statement of levelling-up missions, but it does not commit the Government to implementing them. My right reverend friend the Bishop of London regrets that she cannot be here today, but, with me, she will engage with the Bill with regard to increasing life expectancy and reducing health inequalities. Can the Minister give us some assurance that these issues will be adequately addressed and that the 12 levelling-up provisions will happen?


Extracts from the speeches that followed:

Lord Ravensdale (CB): I wish to make three points. First, on the levelling-up missions and their place within the Bill, the right reverend Prelate the Bishop of Carlisle put it across that we are missing the confidence in the missions and that they really will be achieved. We could do with those missions being explicitly stated in the Bill; that would add weight to the missions and provide the confidence that they will be achieved. The missions have been developed already within the White Paper. In addition, I was somewhat alarmed by the wording in Clause 5—the Government can at any time change or alter those missions. To increase confidence in levelling up, one of the key strategic goals of the nation, there should be some additional control by Parliament of any change to those missions.

Lord Hunt of Kings Heath (Lab): On devolution, this is a Government who have spent the last 13 years continually centralising power, not just in Whitehall but in Ministers through the use of secondary legislation, to give them an extraordinary addition to their powers. Even when devolution is proposed—actually it is not devolution, it is delegation—it is often conditional, and depending on the adoption of a mayoral or combined authority system. Where is the radical skills agenda that needs to be devolved to local level? What about finance for the transport infrastructure and transport operations? I listened very carefully to the right reverend Prelate the Bishop of Carlisle on the links between health and what the Bill is trying to do. Why are we not seeing a transfer of responsibility for aspects of the NHS, as we have seen in Greater Manchester?

Lord Stephens of Birmingham (CB): What, for example, will the Bill actually do for people in Shard End, the part of east Birmingham where I was born? It is in the bottom 10% of most deprived wards in the country and is, as it happens, the most pro-Brexit area in Birmingham, so people there want change, but despite the Bill’s length you would be hard pressed to point to much in it that will practically benefit them. So, as well as amendments on housing, infrastructure and the environment, here are three further suggestions for perhaps more radical reform.

First, we could use the Bill to really drive inclusive and sustainable economic growth. Without it, levelling up collapses into a zero-sum redistributive arm wrestle. Taking my cue from the right reverend Prelate the Bishop of Carlisle, I say that a good place to start would be tackling working-age poor health, which today’s Times reveals costs the economy a staggering £150 billion a year, equivalent to 7% of GDP. It is time to get more creative and more radical. For example, at a time when the economy has an acute labour shortage, consider national insurance tax incentives for employers offering evidence-based physical and mental health workplace support. At a time when the OBR has just hiked its forecast for future incapacity and disability benefits spending by an astonishing £7.5 billion extra a year—which, by the way, far outstrips any earmarked funding for levelling up—it is time to break with the Treasury orthodoxy of AME/DEL accounting. Instead, let us legislate to include a devolution deal option for mayors, combined authorities and local authorities to gain-share with DWP when local initiatives offset future benefits costs

Lord Crisp (CB): The objective of levelling up as set out in the White Paper is a fundamentally important idea which requires a range of linked and funded actions across environmental, social and economic realms; the Bill does not do anything for that at the national level. If I take the very specific issue of the crisis in the NHS at the moment, it is very clear that reform of the NHS—whatever that means to different people—will not be effective without related changes in housing, education, employment, and much more, as the right reverend Prelate the Bishop of Carlisle talked about in his very moving contribution about the social determinants of health. These things are all fundamentally linked.

Baroness Hayman of Ullock (Lab): Health was brought up over and again—the increase in health inequalities that the right reverend Prelate the Bishop of Carlisle, who I call my noble friend, talked about and, as he said, the deep fractures that Covid exposed in our health inequalities. My noble friend Lord Hain talked about the impact of huge cuts on our public services. So it is not just about health; it is right across the board.

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