Baroness Scott of Bybrook:

Moved by Baroness Scott of Bybrook

132: Clause 44, page 46, leave out lines 25 to 37 and insert—“(a) the availability and standards of housing, transport services or public safety,(b) environmental factors, including air quality, and access to green space and bodies of water,(c) employment prospects, earning capacity and any other matters that affect levels of prosperity,(d) the degree of ease or difficulty with which persons have access to public services,(e) the use of, level of use of, tobacco, alcohol or other substances,and any other matters of personal behaviour or lifestyle, including physical activity and diet, that are or may be harmful to health.”Member’s explanatory statementThis Amendment replaces the list of general health detriments.

My Lords, my Amendment 132 is on the general health determinants listed under Clause 44. Under that clause, combined authorities must have regard to improving the health of people in their area. Our amendments would expand the current list of general health determinants to include the availability, as opposed to just the standards, of housing. In addition,

“matters of personal behaviour or lifestyle” as referenced in the Bill are specified to include “physical activity and diet”.

On housing, standards are crucial of course, but housing availability should also be considered as it affects housing insecurity and homelessness. On physical activity and diet, it should be clear to all noble Lords that these are major health determinants. This is common knowledge: dietary patterns are a key determinants of chronic disease, and physical activity is a major factor for preventable disease. In 2023, evidence from the Sport and Recreation Alliance showed that the UK was ranked 11th out of 15 comparable European nations for the levels of physical activity that were undertaken, and that we were the third-highest spender on healthcare costs caused by inactivity. Updating the general health determinants in this Bill would inform fthe health determinants referenced in Amendments 133 and 134 from the noble Baroness, Lady Royall of Blaisdon.

Evidently, there is scope in this Bill to see what more can be done to make our country healthier, based on common sense. I look forward to the Minister’s response to this very short and very simple amendment.

My Lords, I will speak to my Amendments 133 and 134. As we are aware, the UK’s health is fraying and unequal, with increasing numbers of people unable to work owing to poor health. Compared with other high-income countries, the UK now has one the lowest life expectancies and is among those with deepest health inequalities. This has avoidable and negative consequences for individuals, public services and the economy.

Addressing these inequalities requires action at regional level, where leaders have the powers to shape economic growth, create healthy places and reduce inequalities. This Bill provides a timely opportunity to embed health and health equity at the heart of devolved decision-making, and I warmly welcome Clause 44, which is a crucial lever for improving health and reducing health inequalities.

In Committee, I tabled amendments to strengthen this duty and the proposed local growth plans to ensure that all strategic authorities act consistently to improve health, reduce health inequalities and consider health while growing their local economies. My noble friend the Minister responded that she believes the duty as drafted

“will apply to all functions, including developing a local growth plan

However, the Government have not yet provided any detail on how this duty should be fulfilled or how strategic authorities will be held accountable for this. Without this detail, there is a real risk that inequalities will be worsened, with some strategic authorities taking significant action to improve health and others seeing the duty as a tick-box exercise.

To ensure that the duty is as successful as we and the Government want it to be, I have tabled amendments which would require the Government to report to Parliament on the implementation of the duty. I am grateful to the noble Lords, Lord Hunt of Kings Heath, Lord Bassam of Brighton and Lord Bichard, for their support.

The Government previously said that they will monitor the health duty, with Miatta Fahnbulleh, the Minister for Devolution, Faith and Communities, saying that

“we will continue to monitor how the new duty beds in and its impact across the country, so we can ensure that the intent is aligned with practice and delivery

These amendments would formalise the Government’s commitment, providing a mechanism to identify whether further support, guidance, resources or requirements are needed in the future. It would also provide a mechanism to support shared learning across strategic authorities.

The amendments focus on implementation and process rather than outcomes, given the time it takes to see shifts in health inequalities. Information could be collected with a light-touch approach of returns from strategic authorities covering actions taken, strategies produced, partnerships formed, et cetera, and desk research by civil servants. Without these amendments, there is a risk that the new health duty remains well intentioned but inconsistently applied across regions and will therefore fail to have any real impact on reducing health inequalities. This would be a significant missed opportunity to reverse worrying health trends. If the amendments are not acceptable, I hope that the Government will agree to guarantee strong guidance on this issue to ensure that the duty is properly implemented across all regions.

My Lords, I support these amendments. I spoke to Amendment 132 in Committee. I will not repeat what I said then, but I just want to say that the Minister said in Committee that the reason why the Government want to stick with their own wording on Clause 44—a clause that we all support very strongly—was that they did not want to be too prescriptive regarding what areas should be looking at as health determinants. However, if we do not reflect what is known about the determinants of health, we will not be able to set down what we need to measure to evaluate the success of Clause 44, which is so important and which the noble Baroness, Lady Royall, spoke about in connection with her amendments. I therefore urge the Government to look very carefully at these amendments to see whether some adjustments can be made that would make Clause 44 as strong as we all want it to be.

My Lords, I thank the noble Baronesses, Lady Scott and Lady Royall, for their amendments relating to the new health improvement and health inequalities duties. I also thank the noble Baroness, Lady Freeman, for her helpful contribution.

On Amendment 132, I stress our ambition to enable combined authorities and combined county authorities, which are the experts in their local areas, to take a broad view of the factors that shape health and drive health inequalities in their areas. The Bill illustrates a number of important health determinants to give clarity to our intent and indicate areas where authorities are likely to be able to act. It already includes standards of housing and matters of personal behaviour and lifestyle. It also explicitly allows for consideration of any other matters that affect life expectancy or the general state of health.

Setting out large numbers of individual determinants risks restricting flexibility, because it would imply that the specific determinants to be considered are only those which are set out in detail in the Bill. Indeed, the proposed amendment would have the effect of limiting the scope of “general health determinants.” It would set out a narrower list of general health determinants by removing the scope for combined authorities to consider

“any other matters that are determinants of life expectancy or the state of health of persons generally, other than genetic or biological factors”, and focus instead only on matters of personal behaviour and lifestyle, rather than also considering wider public health and systemic matters which might determine life expectancy or the state of health of a person.

I am grateful to my noble friend Lady Royall for her Amendments 133 and 134. However, these amendments would add an unnecessary bureaucratic burden on combined and combined county authorities. The Secretary of State would be unable to make such an assessment without placing detailed reporting requirements on combined and combined county authorities. We want to shift power away from Whitehall and into the hands of those who know their communities best. The requirement for the Secretary of State to make an assessment of the

“consistency of implementation of the duty” is not compatible with our fundamental proposition that combined authorities and combined county authorities are best placed to judge how to put the duty into effect locally.

Furthermore, the requirement on the Secretary of State to define a minimum standard against which to assess authorities would unhelpfully impose a degree of uniformity and have the unfortunate effect of turning a minimum government standard into a default standard. This would constrain local ambition. More broadly, alongside this new duty, we want to simplify requirements in relation to the planning and delivery of health and care services to create more flexibility for areas to respond to the needs of their local populations.

However, I reassure my noble friend that we will pay close attention to how the new duty embeds in the work of combined authorities and combined county authorities to understand the impact that it is having over time, including the different ways in which authorities respond to it. With these reassurances, I ask that the noble Baroness, Lady Scott, withdraws her amendment and my noble friend Lady Royall does not move hers.

I am grateful to the noble Baroness, Lady Royall of Blaisdon, for her amendments. Ensuring that we have a holistic view of housing—not just the quality but the quantity of housing and the role that it plays in health—makes it easier for authorities to respond to this part of the Bill. Explicitly recognising the effects of diet and physical activity on our health is not contentious but will also help authorities to facilitate healthier lifestyles in their communities. I hope that the Minister will give his continued consideration to these amendments.

Amendment 132 withdrawn.

Amendments 133 and 134 not moved.