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.
On 12th January 2022, the House of Lords debated changing mortality rates in the UK in Grand Committee. The Bishop of London spoke in the debate, advocating for greater inclusion of faith groups to aid in tackling health inequalities:
The Lord Bishop of London: My Lords, I thank the noble Lord, Lord Sikka, for securing this important debate. I also look forward to hearing from the noble Lord, Lord Evans, in his maiden speech.
The paper at the heart of this debate provides a useful focus, because it highlights one of the worst health outcomes that we have seen in the past 10 years: that of widening inequalities. It is also helpful because, by focusing on the impact of austerity, we begin to see that public health is impacted by many factors besides healthcare access—factors called the social determinants of health. Those include housing, our jobs, our environment, our education and much more. They can be summed up as the opportunities that we have to lead healthy lives. The Heath Foundation noted that 50% of people in the most deprived areas report poor health by the age of 55 to 59, which is more than two decades earlier than in the least deprived areas. It is not just about life expectancy; it is also about healthy life expectancy.
The debate is poignant also because it comes at a time of great strain on the NHS and on social care, and at a time when those other determinants of health are challenging for many of us. We are also at a moment when I hope we are beginning to realise the importance of prevention of ill health, which is essential for the sustainability of our healthcare system.
The Bishop of St Albans received the following written answer on 9th January 2023:
The Lord Bishop of St Albans asked His Majesty’s Government what estimate they have made of the number of children under five years old who benefit from the provision of free school milk; and what plans they have to expand that provision.
Lord Markham (Con): Approximately 810,587 children received a portion of milk through the Nursery Milk Scheme every school day during 2021/22. There are no plans to expand the provision.
The Bishop of St Albans received the following written answer on 9th January 2023:
The Lord Bishop of St Albans asked His Majesty’s Government why screening of malnutrition is not standard practice in all health settings across England.
Lord Markham (Con): The National Institute for Health and Care Excellence recommends that all hospital inpatients on admission and all outpatients at their first clinic appointment should be screened for malnutrition. Screening should be repeated weekly for inpatients and when there is clinical concern for outpatients. Residents in care homes should be screened on admission and when there is clinical concern.
The Bishop of London asked a question on sustainable workforce concerns among health and social care workers on 19th November 2022:
The Lord Bishop of London: My Lords, we have heard how important a sustainable workforce is, both in social care and healthcare. Can the Minister tell us what the Government are doing to listen to the concerns of health and social care workers about patient safety and their own working conditions at this time?
The Bishop of St Albans asked a question on help for food banks to freeze and store food, during a debate on health and malnutrition on 14th December 2022:
The Lord Bishop of St Albans: My Lords, food banks across my diocese are reporting a huge increase in need and a huge decrease in the amount of food being donated, simply because of the cost of living crisis. One of the things that makes a difference for food banks is having enough capacity to freeze food. There is an urgent need to see whether we can help them with freezers. Is there anything the Government can do to work with food banks to help them increase their capacity for storing food when it is spare so that is available at other times?
The Bishop of London received the following written answer on 14th December 2022:
The Lord Bishop of London asked His Majesty’s Government how many people are currently receiving statutory sick pay; how many people are eligible to receive only statutory sick pay when unwell; and how many people earn less than the lower earnings threshold, making them ineligible for statutory sick pay.
Baroness Stedman-Scott (Con): Statutory Sick Pay is administered and paid by employers, so this information is not held by the Government. Therefore, we are not able to make a robust assessment on the number of people who are currently receiving SSP.
The Bishop of Gloucester received the following written answer on 7th November 2022:
The Lord Bishop of Gloucester asked His Majesty’s Government:
what assessment they have made of the potential merits of enabling local or regional authorities to influence or control the allocation of School Fruit and Vegetable Scheme budgets for their area.
what consideration they have given to reforming the School Fruit and Vegetable scheme (1) to strengthen local procurement strategies, and (2) to enhance the supply of (a) seasonal, or (b) organic, produce to schools.
what consideration they have given to enabling local authorities to have a role, on an initial pilot basis, in allocating funding from the School Fruit and Vegetable Scheme in their area.
The Bishop of London tabled a question for short debate on 3rd November 2022, concerning ambulance handovers in light of an upcoming strike:
The Lord Bishop of London: To ask His Majesty’s Government what progress they are making on ensuring swift ambulance handovers, as set out in Our Plan for Patients, published on 22 September, given the decision of ambulance workers across 11 trusts to ballot for strike action.
My Lords, I start by saying how grateful I am to your Lordships’ House for setting time aside for what I think is an important and timely debate. I am also grateful for the briefing from the House of Lords Library.
Last week, the GMB union announced that it was balloting ambulance workers over strike action across 11 trusts in what would be the biggest ambulance workers’ strike for 30 years. I think it would be wise to ask ourselves what has happened across the whole system to bring us to this point. Ambulance handover delays are an increasing issue across the trusts in England. The NHS contract for this year sets out that 90% of handovers should take place within 30 minutes and 65% within 15. However, the Association of Ambulance Chief Executives notes 40,000 cases of patients waiting longer than an hour for handover—this was recorded this year and is the third-highest volume on record.
Long handover delays increase the risk of harm to patients while they are in ambulances. The NHS Confederation says that eight out of 10 patients who were delayed beyond 60 minutes were assessed as having had an experience that had potentially harmed them, and nearly one in 10 experienced severe harm as a result. The number of ambulances waiting to transfer their patients also impacts on the availability of ambulances, and the response times therefore increase. This in turn risks increasing further harm to those who are waiting for an ambulance in the community. Florence Nightingale famously once said that hospitals should do no harm. It is a sentiment that I believe is appropriate to the wider healthcare system. The healthcare system should do no harm.