My Lords, it is a pleasure to speak in the debate on the Motion for the humble Address. I declare my interests as outlined in the register. There is much in Her Majesty’s gracious Speech to commend it to your Lordships’ House. However, it is unfortunate that it did not include any detailed remarks on the relationship between health disparities and the levelling-up agenda. While there was a valid emphasis on restoring the strength of the economy, it was a shame to hear so little detail on the circumstances that will enable us to economically bounce back: namely, our health.
Thankfully, the actual levelling-up report highlighted health as one of its mission areas, stating:
“By 2030, the gap in Healthy Life Expectancy … between local areas where it is highest and lowest will have narrowed”,
and that, by 2035, healthy life expectancy will rise by five years. The measurement of these missions, along with an independent body to ensure that they are seen through, will be vital to their success and essential in the wider context of health inequalities which we are facing post pandemic. Without these metrics and this accountability, we may well miss the goal of levelling up entirely.
The Health Foundation’s analysis shows that it will take 200 years to meet the goals named in the levelling-up White Paper, meaning that we are at least two generations away from a more equitable society. This is if we maintain what we are currently doing—and we are not. We are losing our healthcare workforce faster than we are replacing it. With a falling number of GPs, dentists and nurses and increasing pressure on the NHS, we are overlooking prevention of ill health and, by not investing sufficiently now in health coverage, we are storing up increased expenditure in the NHS in future. We need a comprehensive and integrated approach to restoring our collective well-being. To achieve the ambitious and worthwhile health missions of the levelling-up White Paper, we must be direct, pragmatic and specifically work them into legislation.
Last year, I launched a Health Inequalities Action Group, bringing together parliamentarians, interfaith leaders, health specialists and civil society leaders to explore how we can improve health outcomes across London and the social circumstances that surround them. In 2022, we hosted a series of community consultations to capture the different experiences. Through this work, we have found that faith groups, if sustainably supported, can continue to improve the work of statutory and civil society organisations to action complex health and social interventions. The action group is drawing out case studies of public health interventions that are modelled on relationships, trust and the mobilisation of resources.
One case study was the visionary community health worker pilot initiated by Westminster City Council. These public health professionals are trusted, permanent and regular visitors who are integrated in the community and connected to the local primary care teams and other relevant bodies necessary for community flourishing. This pilot was modelled after the Brazilian family health strategy, which began in 1994 and is now the primary care system in Brazil.
Brazil shares many of our disparities; research in this area by British GPs who have worked in Brazil laid out a rationale for why we should use this system in the UK. A national study in Brazil, featured in the British Medical Journal, showed that residents in areas with a long-standing coverage of community healthcare workers had a 34% lower cardiovascular disease mortality rate compared to areas without them. The benefits of such an approach to community care, and arguably the entire levelling-up programme, are clear.
I have said before that the vision we should be striving for is one of mutual flourishing, generosity and abundance. This is also known as the Jewish and biblical concept of shalom, which can be summarised as experiencing wholeness or a state of being without gaps. Together with those working for a more whole and healthy society, I would like this Government to act in line with the NHS long-term plan, which focuses on prevention and early intervention to reduce healthcare costs and the burden of disease. I would like this Government to adopt models and practices that embody efforts to design a more holistic health service—this is in effect aimed at achieving shalom—not just the absence of disease. It is an approach that needs to happen if we are to take the levelling-up agenda seriously.