New Clause 3 - Review of public health, inequality and poverty effects of Act

Finance Bill – in a Public Bill Committee at 2:30 pm on 16 January 2024.

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“(1) The Chancellor of the Exchequer must review the public health, inequality and poverty effects of the provisions of this Act and lay a report of that review before the House of Commons within six months of the passing of this Act.

(2) The review must consider—

(a) the effects of the provisions of this Act on the levels of relative and absolute poverty across the UK including devolved nations and regions,

(b) the effects of the provisions of this Act on socioeconomic inequalities, and on population groups with protected characteristics as defined by the 2010 Equality Act, across the UK including devolved nations and regions,

(c) the effects of the provisions of this Act on life expectancy and healthy life expectancy across the UK including devolved nations and regions, and

(d) the implications for the public finances of the public health and NHS effects of the provisions of this Act.”—

Brought up, and read the First time.

Photo of Debbie Abrahams Debbie Abrahams Labour, Oldham East and Saddleworth

I beg to move, That the clause be read a Second time.

It has been a pleasure to serve under your chairship during today’s proceedings, Mr Paisley. New clause 3 would compel the Chancellor to assess the impacts of the Finance Bill on poverty, inequality, and health and healthcare demand across the UK, and to lay a report before the House within six months of Royal Assent.

Let me expand a little on why the new clause is so important. This is the first opportunity I have had to come to a Finance Bill Committee to advance these arguments, although I have regularly made them on Report and Third Reading. The new clause partly reflects my experience as a former public health consultant and academic, and relates to one of the reasons that I became an MP. It is about tackling health inequalities. It is not about changing anything in the Bill; it is about understanding what its impact will be. It is about our not working in silos and understanding the Bill’s impact on the NHS, education and so on. That is why I tabled it.

The new clause is also about transparency, to which the Prime Minister is very committed. It will have an important impact on the electorate’s lack of confidence not just in the Government, but in politics and all politicians. It is important that we are seen to be transparent and to be evaluating the work that we do. We can do that in a prospective way that anticipates what the impacts will be.

Finally, although the Government have a massive commitment to levelling up, we are experiencing one of the biggest health divides since 1980. I refer to 1980 because that was when our real understanding of the relationship between poverty and health began. The Black report was in 1980, and it was followed by Dame Margaret Whitehead, my former colleague at the University of Liverpool, authoring “The Health Divide”, which described the socioeconomic inequalities that drive health inequalities. Of course, that was in post-war Britain—a Britain with the NHS. Everybody thought that the NHS would be the saviour that would end all our health woes.

Evidence of the relationship between poverty and health has increased. “The Spirit Level”, by Professors Pickett and Wilkinson, showed that this is a universal experience and not just one in the UK. Health is driven by inequalities in societies right across the world. Indeed, it is almost a universal law that most of the societies with the smallest gaps between rich and poor do better than other societies, not just in health but in social mobility, crime reduction, increasing trust and so on, which are things that I think all of us here would subscribe to.

Then there is Professor Sir Michael Marmot’s totemic 2010 work, “Fair Society, Healthy Lives”, which set out six objectives that we as a country need to meet to address socioeconomic inequalities and the resulting health inequalities. He warned us in 2017, when he was monitoring the progress towards those six objectives, that we were one of the few developed economies in which life expectancy was flatlining. Then, in 2020, just before the pandemic, he published his 10-year review, which showed that life expectancy was not only flatlining but actually declining for women and in the most deprived parts of our country. We shared that unenviable state with the United States and Iceland; with us, they were the only advanced economies where life expectancy was declining. Indeed, that review was about not just our life expectancy but our healthy life expectancy—how long we could expect to live in good health and how long we would be active in the labour market. Finally, he noted that there was an even more stark north-south health divide.

Then covid hit. Would you believe it? It has not come out very much, but we saw exactly the same patterns of ill health, infection and death during the pandemic as we had seen before the pandemic in other conditions, such as heart disease. Sir Michael provided another update just last week in a report called “Lives Cut Short”. He said in The BMJ just yesterday that

“if everyone had the good health of the least deprived 10% of the population, there would have been 1 million fewer deaths in England in the period 2012 to 2019. Of these, 148,000 can be linked to austerity. In 2020, the first year of the covid pandemic, there were a further 28 000 excess deaths.”

As I said, I speak as a former academic who specialised in public health. To date, I have seen no evidence that policymakers are taking this issue on board and learning these lessons; indeed, we are failing to learn the lessons not only from an economic perspective but from the perspective of social justice. I urge people to watch a short film called “The Unequal Pandemic”, which shows not only the human cost of this situation but the evidence behind it.

Regarding evidence, I know that the Ministers will be interested in the fact that the Northern Health Science Alliance has argued that the relationship between health and wealth must be looked at, and that health and wealth must be looked at together. The alliance has calculated that improving the health of people in the north of England to the level of people in the rest of England would increase productivity by £13.2 billion a year. It is, therefore, in the Chancellor’s interest to do a full health assessment of all the measures in the autumn statement.

I am the chair of the all-party parliamentary group on health in all policies, which seeks to assess the health effects of Government policies. We have assessed a couple of Government policies already—people can see those assessments on my website—so I know that assessing the health effects of all Government policies is possible. It is not about primary data collection; it is about looking at secondary data and modelling it to see what the health impacts of policies are. It is possible to do this work.

Mr Paisley, thank you very much for your indulgence. Professor Sir Michael Marmot finished his piece in The BMJ by asking us to provide hope that we, as politicians, recognise and understand that we cannot go on like this. I agree with him. I will not press my new clause to a vote, but I urge Ministers to consider this matter seriously.

Photo of Nigel Huddleston Nigel Huddleston The Financial Secretary to the Treasury

I should state at the beginning of my remarks that I completely understand the intent of new clause 3, because the hon. Lady is raising issues that are of great concern to hon. Members right across the House. However, she will not be surprised to hear that, once again, I respectfully disagree with her on the need for these assessments. We believe the proposed new clause is redundant because there are existing mechanisms in place to monitor and evaluate the impact of Government policy on public health inequality and poverty.

Photo of Debbie Abrahams Debbie Abrahams Labour, Oldham East and Saddleworth

On that basis, I did ask a question at the autumn statement. In relation to the social security measures, I asked what were the anticipated impacts on the health of social security claimants. I have heard nothing back from anyone on that. If that evidence exists, what is it?

Photo of Nigel Huddleston Nigel Huddleston The Financial Secretary to the Treasury

I shall respond to the hon. Lady on the plethora of analysis and support that goes on for a range of policy areas. We are not lacking in either interest in this area or consideration of impact. As I said, there are numerous Government Departments, bodies and other mechanisms already in place to systematically collect, monitor and evaluate the impact of Government policy across the UK.

The Department of Health and Social Care and its arm’s length bodies are responsible for developing and evaluating policies to help people to live more independent, healthier lives for longer. As part of DHSC, the Office for Health Improvement and Disparities works across DHSC, the rest of Government, the healthcare system, local government and industry, to shift focus toward preventing ill health, particularly in places where there are the most significant disparities. DHSC also invests in research and evaluation through the National Institute for Health and Care Research, which delivers robust evidence to inform policy development and implementation, including evaluation of policies and research to fill longer term evidence needs and gaps.

The Treasury carefully considers the impact of its decisions on those sharing protected characteristics, in line with both our legal obligations and our strong commitment to providing fairness. We go beyond our legal requirements by publishing a summary of equality impacts for tax measures within the tax information and impact notes alongside the Finance Bill.

Various parts of Government, including from within the Cabinet Office’s equality hub, promote the Government’s commitment to levelling up opportunity and ensuring fairness for all. The hub includes the Government Equalities Office, the Race Disparity Unit, the Disability Unit, and the Social Mobility Commission, all of which provide valuable input.

As I mentioned in answer to new clause 2, since 2010 the Treasury also publishes an “Impact on households” report at major fiscal events, but I will not repeat the comments I made there. The “Households below average income” report also provides valuable input. For example, in 2021-22, there were 1.7 million fewer people in absolute poverty after household costs than in 2009-10, including 400,000 fewer children, 1 million fewer working-age adults, and 200,000 fewer pensioners. We believe the mechanisms currently in place are effective in providing the necessary insight, so I urge the Committee to reject new clause 3.

Clause, by leave, withdrawn.

Question proposed, That the Chair do report the Bill to the House.

Photo of Nigel Huddleston Nigel Huddleston The Financial Secretary to the Treasury

On a point of order, Mr Paisley. Before you conclude your comments, I think this is an appropriate opportunity for me to make similar comments and thanks to those made by my opposite number. I agree with everything he said. I put on record my thanks to you, Mr Paisley, and your co-Chair, who did not have the opportunity to participate in this Bill; there will be other opportunities in the future.

Of course, I thank the Clerks and all officials who have worked on this Bill across multiple Government Departments, including His Majesty’s Treasury and His Majesty’s Revenue and Customs, but it goes well beyond that. I thank members of the Committee in this place, and also members of the House of Lords Sub-Committee for their input and work. I also thank all those stakeholders who have provided invaluable input. Some have provided specific input recently in the form of written submissions to this stage of the process, but many have participated over many years in extensive formal and informal consultations. I put on record our deep gratitude and thanks to all those who have taken their responsibilities and interests incredibly seriously, providing great input into this Bill to date.

Photo of Ian Paisley Jnr Ian Paisley Jnr Shadow DUP Spokesperson (Communities and Local Government), Shadow DUP Spokesperson (Culture, Media and Sport)

Thank you for those comments, Minister. We have had a brace of Ministers, shadow Ministers and Committee Clerks. We did not have a brace of Chairs, but we did have the Statler and Waldorf-esque Parliamentary Private Secretaries in a brace. Thank you all for this vital work that Parliament does. The line-by- line scrutiny of the Bill is serious work, and people taking their time to really do this line-by-line is appreciated. I know that the staff, Clerks and Hansard will be appreciative of your kind comments, Minister, and yours too, Mr Murray.

Question put and agreed to.

Bill accordingly to be reported, without amendment.

Committee rose.

Written evidence reported to the House

FB01 Low Incomes Tax Reform Group—Clause 16 and Schedule 10—Provision relating to the cash basis

FB02 Low Incomes Tax Reform Group—Clause 36— Commencement of rules imposing penalties for failure to make returns etc

FB03 Chartered Institute of Taxation—Clause 16 and Schedule 10—Calculation of trade profits etc (cash basis)

FB04 Chartered Institute of Taxation—Clause 35— Additional information to be contained in returns under TMA 1970 etc

FB05 ICAEW Tax Faculty—Clause 14 Provision in connection with abolition of the lifetime allowance charge, and Schedule 9 Pensions

FB06 ICAEW Tax Faculty—Clause 35 Additional information to be contained in returns under TMA 1970 etc

FB07 Chartered Institute of Taxation—Clauses 13-15 and 17, relating to Employment Taxes and Pensions

FB08 Chartered Institute of Taxation—Clauses 3-7 & Schedules 2-6, relating to Creative Reliefs (Films, television programmes, video games etc)