Baroness Lister of Burtersett Portrait Baroness Lister of Burtersett (Lab)
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My Lords, I rise to move Amendment 4, which is supported by the right reverend Prelate the Bishop of Durham and the noble Baronesses, Lady Stroud and Lady D’Souza, to whom I am very grateful, even though they could not all be in their places. I also give my support to Amendment 7 in particular. I am also grateful to Action For Children, and Paul Wright of Children’s Alliance, for their support.

The amendment would add a child poverty mission to the existing list of levelling-up missions, but it does so in a very different way to that put forward in Committee. I will explain that in a moment but first, I will give a very brief recap of the case. The latest official figures show that over 4 million—nearly a third—of all children are living in poverty. There is an even higher proportion among some minority ethnic communities and a growing problem of deep poverty, as demonstrated by the Social Metrics Commission, chaired by the noble Baroness, Lady Stroud.

While poverty rates vary regionally, Tower Hamlets stands out as the local authority with the highest rate—nearly 50%, according to my colleagues in the Centre for Research in Social Policy at Loughborough University. They used government data, which also show that children are more likely than the overall population to be in low-income households, so it is perhaps not surprising that the Trussell Trust has found that nearly half of all households experiencing hunger include children —a significantly disproportionate number. This is among the latest in a flood of reports I have received, since we debated the issue in Committee, documenting the hardship experienced by children in low-income families.

As I pointed out in Committee, both the Levelling-Up Secretary and the former Prime Minister who introduced the levelling-up strategy have acknowledged that it has to address poverty, in particular child poverty. That child poverty was not mentioned in the White Paper was, according to Mr Johnson, an accident, but the accident has not been rectified. Indeed, the opportunity to do so in Committee was rejected, despite strong support for a child poverty mission throughout the House. Moreover, it was disappointing that the suggestion of the noble Lord, Lord Young of Cookham, that poverty might be written into the existing missions was simply ignored. Mission 2, on opportunities, would, I suggest, be the obvious place to do so.

The Minister’s rejection of the previous amendment in Committee appeared to be based on three propositions. The first was that such a strategy was unnecessary in light of the usual list of what the Government are already doing, together with an example of local authority action to support child poverty reduction at local level. Listing various initiatives does not constitute a strategy. While the anti-poverty strategies pursued by some local authorities are indeed inspiring, it was clear from a recent event organised by Greater Manchester Poverty Action that, despite the good work they are doing, what local authorities are able to achieve is hampered by the lack of a national anti-poverty strategy.

Secondly, on the much-repeated mantra that paid work is the best route out of poverty, it is certainly an important route, but for all too many it represents a cul-de-sac if it simply means in-work poverty. It is not an argument against a wider interdepartmental strategy.

Thirdly, there is the Government’s aversion to income-based targets. I do not accept the Minister’s argument, nor do most academics or charities working in the area, but I shall spare noble Lords a debate on this. Instead, in a spirit of compromise, I have redrafted the amendment to address her concerns so that it now refers to

“poverty in all its dimensions”.

This phrase is taken from the UN sustainable development goal 1.2, which commits all signatories to work to

“reduce at least by half the proportion of men, women and children of all ages living in poverty in all its dimensions”

by 2030.

Noble Lords who are not familiar with the sustainable development goals might think that this is an odd commitment to include in domestic policy but, as was made clear in a 2019 Written Statement from the Department for International Development, these goals apply to all people in all countries, including here in the UK. The amendment is in fact much less prescriptive than the goal itself but, given that the UK Government are committed to meeting the sustainable development goals and the then Secretary of State acknowledged that

“there is more work to do if we are to meet the ambitious targets by 2030”,

I hope the Government accept that this amendment would help them to do so. They might not like targets, but I am afraid that they are committed to the SDG target.

In Committee, the Minister accepted that child poverty is an issue that needs to be acted on. I am grateful to her for meeting me and the right reverend Prelate last week to propose a welcome, albeit small, concession by way of introducing child poverty statistics into the levelling-up metrics, which I shall leave her to spell out. But again, that alone does not constitute a stratagem. The Westminster Government remain the only Government in the UK without any kind of child poverty strategy, despite the 2021 recommendation for such a strategy from the Select Committee on Work and Pensions.

In conclusion, I would like to quote from a short film shown recently in Westminster by the Food Foundation, focused on Melissa, a mother from Solihull who is struggling to make ends meet. Speaking of families in poverty generally, and of politicians, she said:


the politicians

“know we’re here, but they don’t see us”.

The inclusion of a child poverty mission in the levelling-up strategy would be a tangible way for the Government to say, “We do see you and we are serious when we say we are committed to eradicating child poverty”. I beg to move.

Baroness Finlay of Llandaff Portrait Baroness Finlay of Llandaff (CB)
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I declare an interest in that I am vice-president of Marie Curie and co-chair of the Bevan Commission on health in Wales. I shall speak principally to Amendment 7 in this group, which is based on the previous amendment in Committee from the right reverend Prelate the Bishop of London, who is also a signatory to this amendment.

The levelling up White Paper, the precursor to the Bill, published in February 2022, identified that:

“One of the gravest inequalities faced by our most disadvantaged communities is poor health”.

Yet health disparities are not explicitly specified in the Bill and the health disparities White Paper has been scrapped, hence this amendment. In Committee the Minister stated that the Government are committed to working with the devolved Governments to reduce geographical disparities across the whole UK and to share evidence and lessons from across the country, learning what works and what does not. Today we have already heard the Minister re-emphasise this in summing up on previous amendments.

Levelling-up missions must address inequalities right across the life course, from cradle to grave. Tackling health inequalities is essential to improving the nation’s economic health as well as people’s well-being. Inequalities in life expectancy are the result of poor health literacy and those broad social determinants of chronic illness and poor health. The Bill purports to reduce geographic disparities using a range of mechanisms. There are marked regional differences in health outcomes across the nation; within and between regions, disparities are increasing.

The largest decreases in healthy life expectancy were seen in the most deprived 10% of neighbourhoods in the north-east. Between 2017 and 2019, healthy life expectancy at birth for women in the north-east of England was 59 years, 6.9 years less than for women in the south-east; for men, life expectancy was 5.9 years shorter. Alarmingly, ONS data showed that healthy life expectancy was around 19 years shorter in the most deprived compared with the least deprived areas of the nation. In these deprived areas, people had a more than threefold risk of dying from an avoidable cause. Before the pandemic, health inequalities were estimated to cost the UK £31 billion to £33 billion each year in lost productivity, £20 billion to £32 billion in lost tax revenue and higher benefit payments, and almost a fifth—£4.8 billion—of the total NHS budget.

The pandemic sharply exposed the real impact of health inequalities through excess mortality in some population groups, and exposed a number of related socioeconomic factors and regional conditions that exist across the life course. Poor housing, inadequate diet, including maternal malnutrition, and adverse childhood experiences have long-term consequences, including crises in adult life, greater need for NHS and social care support and poorer employment prospects. Living on a low income is a source of stress, and emerging neurological evidence suggests that this affects the way people make health-affecting choices, ranging from food to activity.

Poor-quality and overcrowded housing is associated with increased risk of cardiovascular and respiratory diseases, depression and anxiety. Access to good-quality green space improves physical and mental health and lessens obesity. Deprived inner-city areas have far less good-quality green space and higher atmospheric pollution. Unemployment is associated with lower healthy life expectancy and poorer physical and mental health, for unemployed individuals and their households. In 2019-20, employment rates in the least deprived decile were 81.5%, compared with 68.4% in the most deprived decile. Such unemployment damages the nation’s economy.

These health inequalities, starting in childhood, persist right through to the end of life, when social disadvantage is often exacerbated by regional disparities, leaving palliative care needs unmet, particularly for those 90,000 people who die in poverty and deprivation, and those in rural areas where a quarter of the population are aged over 65, unlike younger urban populations. In the UK, those living in poverty, particularly in the most deprived areas, are more likely to die in hospital than in the community and have more emergency hospital admissions in the final months of life. When they leave bereaved children, these young people have worse long-term outcomes in mental health, employability and so on.

The Bill could break the cycle for many if it truly focuses on the population rather than being diverted by commercial short-termism. This is not about taking away from some to give to others: levelling up must address overall well-being and health inequalities across the life course for us to be an economically stronger nation. Without this as a common thread and a foundation for all missions, attempts to level up will fail. I hope that I will get overwhelming reassurance from the Minister today, because otherwise I will be really tempted to test the opinion of the House on this important issue.

Baroness D'Souza Portrait Baroness D’Souza (CB)
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My Lords, I thank the noble Baroness, Lady Lister, for tabling this amendment, to which my name is attached. The stated intention of the Bill, reiterated many times by the Government in both Houses, is the moral duty to reduce economic, social and environmental disparities between and within different parts of the UK. I will make two points.

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Moved by
7: Clause 1, page 2, line 3, at end insert—
“(2A) When preparing a statement of levelling-up missions under subsection (1), a Minister of the Crown must include a mission to address health disparities, aimed at reducing gaps in healthy life expectancy between communities, and addressing disparities in health outcomes throughout people’s life course.”
Baroness Finlay of Llandaff Portrait Baroness Finlay of Llandaff (CB)
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My Lords, I am grateful to the Minister for her response, but I have to say that, without health, a nation cannot thrive. There has to be a thematic ambition across all departments if any levelling up is to get anywhere. I wish to test the opinion of the House.