On Wednesday 22nd February 2023, the House of Lords debated the Levelling Up and Regeneration Bill in the second day of committee. The Bishop of Leeds spoke in the debate, supporting amendments by the Bishop of London and other peers relating to health disparities:
The Lord Bishop of Leeds: My Lords, at Second Reading, I remember applauding, broadly speaking, the ambitions of the White Paper. However, I share the concerns of the right reverend Prelate the Bishop of London, who of course brings to this much more experience than I do.
I am pleased that, already, the noble Baroness, Lady Hayman, has alluded to the interconnectivity of all these different missions; they cannot be seen in silos or in isolation. For example, if you have children who are turning up at school unfed or living in poor housing, you can try teaching them what you will but it may not be very successful, and that has an impact not only on individuals but on communities and their flourishing.
I will speak to Amendment 15, tabled by the right reverend Prelate the Bishop of London, and briefly to Amendments 7, 30 and 31. Health disparities require discrete attention in the Bill. It is not an optional extra. The Bill as it stands states the missions but does not provide mechanisms for action or accountability. How will we be able to measure whether they are effective or not? The right reverend Prelate the Bishop of London has said that, although assurances by the Minister are very welcome, they are not enough; they have to be backed up in the Bill with measurable implementation gauges.
Good health is key both to human—that is, individual—and social flourishing. As I said, we cannot separate out such things as housing, education, health, transport and so on as if we can solve one without having an impact on the other. However, there are inequalities between the regions in many of these areas. I speak from a context in the north: the whole of west Yorkshire, most of north Yorkshire—but do not tell the right reverend Primate the Archbishop of York that—a chunk of Lancashire, one slice of County Durham and a bit of south Yorkshire. The inequalities are serious. The economic squeeze, in the words of the right reverend Prelate the Bishop of London, is an incubator for inequalities, and we know the impact that inequality has across the board.
The White Paper rightly recognises the centrality of health to levelling up, but the actions by which this will be achieved could be argued to be lacking—and we certainly need long-term solutions and not quick fixes or slogans that sound good but do not lead to content. Can the Minister therefore offer assurances of the Government’s commitment to health within the levelling-up agenda in ways that can be measured and accountability upheld?
Extracts from the speeches that followed:
Baroness Pinnock (LD): We had a really good debate on health disparities and the social determinants of health, which we may be able to do something about if we put the missions in the Bill. Obviously I support what the noble Lord, Lord Best, and the right reverend Prelate the Bishop of Leeds said on their concerns about how we measure that. I am open to whatever measure we think will work to improve the healthy lives that people can lead.
It is all tied up in these wider determinants of health, as is housing, which my noble friend Lord Stunell ably explained when speaking to Amendment 20. We are anxious for safe homes. If the cladding scandal has taught us anything—it should have—it is that we need to really focus, even more than the Building Safety Act has, on creating safe homes for people. It is not just safe buildings but safe environments for those homes. I hate the word “affordable”, so we will get that changed if we can.
Baroness Bybrook (Con): I turn to the importance of community-centred ways of working, which the right reverend Prelate the Bishop of Leeds brought up. Recognising this, the NHS has committed in its long-term plan to improving access to community care and things such as social prescribing. The number of social prescribing referrals is a key metric used to measure progress on implementation of this commitment. Indeed, as of October 2022, there were already 2,793 link workers in place, who have already taken over 1.3 million referrals and continue to do that, thereby improving lives in communities across the country.
My noble friend Lord Lansley brought up the issue of metrics. The missions are supported by a range of metrics to measure them, taking into account a wider range of inputs, outputs and outcomes needed to drive progress. Metrics cover a whole wide range of policy issues. We worked across government to identify these missions and metrics, most appropriately for tracking progress. They are deliberately stretching and designed to force innovative thinking, as I know my noble friend would expect.
The reason we focus on healthy life expectancy incentives and activities across life is that they will incentivise activities across the life course and drive the prevention of the breadth of causes of ill health. If you talk to anybody in the health service, you will learn that prevention will be one of the important issues for them in the future. This not only impacts on mortality but supports a more rounded target which aligns with the levelling-up agenda. It seeks to ensure that people live longer, in good health, and are able to work, and therefore to contribute to local economies and national productivity, and place less demand on public services.
The noble Baroness, Lady Hayman, the noble Lord, Lord Best, and the right reverend Prelate the Bishop of Leeds brought up health disparities very strongly. We believe, as a Government, that this is of course a very important issue to the country as a whole. In January this year, we announced that we will be publishing a major conditions strategy to achieve integrated whole-person care. It will alleviate pressures on the health system, increase the healthy life expectancy and tackle conditions that contribute to morbidity and mortality.
Baroness Hayman of Ullock (Lab): My Lords, this has been a really important discussion, not just more broadly around the missions and the metrics and whether they should be in the Bill, but the debate we have had about health and health inequalities—that has been extremely important. I thank the noble Lord, Lord Best, for introducing the right reverend Prelate the Bishop of London’s amendment. It is a very important amendment on the issues of health inequalities getting worse. The noble Lord talked about the 19-year gap between the wealthiest and poorest communities, and I think that is very shocking. The right reverend Prelate the Bishop of Leeds picked this up and talked about the serious inequalities in Yorkshire and the importance of long-term solutions and also referenced the importance of social prescribing. I absolutely agree with him that this is something that needs to be taken more seriously and more into account.
What really concerns me are the health ambitions in the White Paper. If we are to tackle what we have just been debating, they really will not cut it—they will not meet this huge challenge. We have talked about metrics, but I want to talk about metrics in the health section. One of the key metrics is that the “ambitious set of proposals” will
“go further on reducing disparities in health … in the forthcoming Health Disparities White Paper”,
but where is it? It has gone; it has been ditched. How can we have a metric on one of the most important things we need to tackle to achieve levelling up when one of the major parts of the metric is no longer in existence? I would be grateful if the Minister could address that point.
Baroness Taylor of Stevenage (Lab): If the Bill is to be true to its title as a levelling-up Bill, it must surely take the serious aspects of regional disparities as essential to making the Bill work. The amendments in this group—I support the amendment proposed by the noble Lord, Lord Shipley, as well—are tabled to ensure that the geographical differences between communities are properly assessed so that a baseline can be established and success then measured. The right reverend Prelate the Bishop of Leeds said that without evaluative processes in the Bill they are just aspirations, and I agree. We can have as many dreams as we want about what might happen but, if we do not actually say where we are trying to get to, it is like setting out on a journey without a destination in mind. You do not know where you are going to end up, and that is really key.
The evidence on disparities between and within communities in the UK is irrefutable. The Government’s own figures show that 37% of disposable household income in the UK went to just one-fifth of individuals with the highest incomes, while only 8% went to those with the lowest. The Equality Trust has demonstrated just how unequally wealth is spread across the UK, with the south-east having median household wealth that is well over twice that in the north of England. It is true to say that some of this is driven by property wealth, but with the north-east, Wales, Yorkshire and the Humber and the east and West Midlands at less than half the wealth of London and the south-east, the impact on economic opportunities is stark. The Equality Trust research states that the UK has the highest level of income inequality than any other European country other than Italy.
The right reverend Prelate the Bishop of Leeds referred to the need to have discrete attention paid to the most serious causes of inequality, which is absolutely correct. We had a debate under the previous group of amendments around health inequalities. Those key areas of disparity between our regions are stark. The Health Foundation shows, for example, that a 60 year- old woman in the poorest areas of England has a level of diagnosed illness equivalent to that of a 76 year-old woman in the wealthier areas. Children in poorer areas are much more likely to be living with conditions such as asthma and epilepsy and, as they get into their 20s, with chronic pain, anxiety and depression—and for the over-30s in those areas there is the prevalence of diabetes, COPD and cardiovascular disease. There are demographic differences, too, with people from ethnic backgrounds all having higher levels of long-term illness.
We have already commented on the missing health disparities White Paper. It is terrible that that has been scrapped, because it would have made the assessment of levelling-up needs in relation to health far easier. We need to find out from the Minister what has happened to that health disparities White Paper. We will continue to support work which means that the Bill will show how levelling up will tackle health inequalities.
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