Health Bill

Baroness Pidgeon Excerpts

Committee stage
Wednesday 28th October 2026 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, I welcome the Minister’s discussions with the devolved Governments and her saying that nothing is going to be potentially imposed on them, particularly having had those discussions. But can she clarify what will happen to some of the prevention agendas that have been in place—such as the Couch to 5K programme, for which I understand no outcomes have been collected, but which has been part of NHSE and the department’s promotion of exercise—and whether these programmes will be increasingly promoted across England as part of the prevention agenda, and in discussion with the devolved Governments, so that we get consistency in prevention across the United Kingdom?

[Baroness Pidgeon (LD)]

My Lords, we welcome these Government amendments, which ensure that the devolved Administrations’ boundaries are protected and that there is proper consultation and agreement. But devolution must be integral to any legislation from the start, rather than an afterthought. Granted, there has been consultation with the devolved Governments, but these amendments were tabled very late and this is a worrying sign. It is an indication that aspects of the reorganisation and its governance implications had not been properly thought through at the start—through the lens of the devolved Administrations, rather than simply through that of Whitehall and civil servants centrally. The Minister’s words have provided some assurance, and I look forward to the devolved Administrations being at the start and the heart of legislation such as this in the future, rather than an add-on at a late stage.

[Earl Howe (Con)]

My Lords, it is a pleasure to begin our Committee consideration of the Health Bill, and I look forward to the discussions over the coming days. I am grateful to the Minister and to the Government for bringing forward these amendments, which we understand to be principally technical in nature, although there are questions we shall want to ask in later groups about cross-border patient referrals and related issues. We welcome the clarification these amendments provide regarding the consent of the devolved Administrations and the exercise of powers by devolved health bodies, and we are content to support them.

I hope the Committee will allow me to take this opportunity to acknowledge the letter sent by the Minister this morning concerning Healthwatch. Noble Lords across the House will welcome the Government’s decision not to proceed with its abolition, and I am grateful to the Minister for listening to the concerns raised in this House and elsewhere. This is a very positive example of the Government engaging constructively with the scrutiny of this Bill and showing a willingness to reconsider their proposals where legitimate concerns have been raised. That is precisely the spirit in which I hope we can continue our consideration of this legislation, and I welcome the approach the Government have taken on this occasion. I look forward to the Minister’s response.

--- Later in debate ---

[Lord Mawson (CB)]

My Lords, I found this an interesting debate, and I am sympathetic to the amendment of the noble Baroness, Lady Bennett, and particularly that of the noble Lord, Lord Patel, because he is right that very little is actually being learned. My colleagues and I have listened, over the years, to lots of conversations about health inequalities. When you spend your life in very challenging housing estates and see very little changing, you know about the distance between all the words and the practice.

That is why, many years ago, we decided to focus on practice and the doing of things, rather than the talking about things. We began to realise what every parent knows: that you only really learn by doing. When I started to work with GPs, originally in east London, they began by telling me that was how you became a GP. You saw one, you did one and then you taught one; it was a very practical matter. Businesses and entrepreneurs nowadays know that you learn by doing things. Yet in the state, which often feels so out of date in the NHS, there is no learning by doing culture. There is a learning by writing very fine reports, often at 60,000 feet, that seem very unengaged with practice.

Over the years, it has been interesting to observe what happened through practice. The Bromley-by-Bow model is well known, so I will not use it, but the noble Earl, Lord Howe, knows that I was also responsible for the transformation of a street following a murder and 10,000 illegal injections being given out in a housing estate. There were some terribly violent circumstances going on at the time. When I brought the first key people on the street together, all of them—the GP, the school and the housing association—were saying, “We cannot deal with this on our own. We need to do it together. These things are so interconnected”, and we built together the St Paul’s Way Transformation Project, which started with nothing and led to a new £40 million school, a £16 million health centre, 600 homes and now a new primary school.

We joined it up, and Professor Brian Cox and I led our 14th science summer school in June this year, with a masterclass at the end of it on quantum physics, for the children from the same housing estates. It is the same children and same families, and now they have one of the best performing schools in Tower Hamlets. The noble Earl, Lord Howe, helped us greatly at one key point with learning by doing, when he met the whole group—housing, health and education—when the NHS was getting in the way of us completing on the deal for the health centre. He was very helpful in enabling that to actually happen.

It was Duncan Selbie, the chief executive of Public Health England in 2015, who gave me £20 million and said, “Andrew, take this culture that you’ve been developing into the north of England”. We built 10 learning by doing innovation platforms in Rotherham, Bradford, Doncaster and Bootle, all of which were about bringing people together to learn about these matters. It was interesting that when I met the public health officials in each of these places, who were lovely people quoting all the same data that I had heard many times before, and said to them, “What are you actually going to do about that data?”, there was absolute silence. It was not their fault. They did not have the skills to know how to turn fine words into practice for some of the most challenging communities in this country.

It is my view that one of the things being missed in this moment is the serious need to get real about innovation and learning by doing. My colleagues and I—I declare my interests—are at the moment creating at place, on the ground, with local people and professionals, what we call these learning by doing innovation platforms, so that we bring together the actual GP, business person and local resident, and you begin to explore these issues together because in the modern world, health is everybody’s business. It is not just a matter for GPs. It is interconnected and we need to explore what that means.

My concern about where we are at the moment in discussing this Bill, which is a fantastic opportunity for this Government, and this country, to move into a form of health that is of this century and not last century, is that we are going to end up building a lot of biomedical boxes around this country that do not explore these interfaces in some of our most challenging communities. The noble Lord, Lord Patel, is right; we need to worry about why he is right and why things are not being learnt.

I finish with the thought that it is our experience over the years that, sadly, we have to say that, in so many respects, the NHS is not a learning organisation. We must have hosted 70 Government Ministers to our work over the years. They all come and say, “Wow, this is fantastic, we need to do more of it”. I can name the four who did anything practical about that, and the other 66 sit on a list in this pocket. This is not to do with bad people. It is about whether, as a nation, we are now going to get upstream into prevention and health creation and create a learning by doing environment in which we all learn together, and in which local people are part of all of that process.

[Baroness Pidgeon (LD)]

My Lords, this is a very important group of amendments, and it has been a really excellent debate. One of the most pressing issues facing us is the widening gap in health outcomes between different communities. Healthy life expectancy has fallen in recent years and the gap between the most and least deprived areas of England, as we have heard, now stands at almost 20 years.

The point made earlier by the noble Lord, Lord Crisp, when he talked about the role of the department being one of leadership for health across government, not just running the NHS, is really important as we approach this group of amendments. We have heard clearly that the current legislative framework places relatively weak duties on government to address these wider determinants of health and tackle inequalities.

The House of Commons Health and Social Care Select Committee, in its scrutiny of the Bill, called for a stronger focus on improving the nation’s health and tackling inequalities, emphasising the need for clearer accountability and a more robust approach to prevention across government. Many of the amendments in this group would help to achieve that aim by ensuring that reducing health inequalities becomes a central objective of health policy, and that progress is measured and reported transparently.

My noble friend Lady Walmsley’s amendments, spoken to by my noble friend Lady Tyler, and Amendment 7 from the noble Lord, Lord Patel, would strengthen the duty on the Secretary of State to take steps or action, rather than simply “have regard to”. That is really important. Amendment 14, tabled by the noble Lord, Lord Patel of Bradford, and supported by so many Members of the House today, would require the Secretary of State

“to have specific regard to reducing inequalities”

in coastal communities. The point has been made clearly about the added complexities for such communities, whether those are workforce related or in local service provision. Those are really important.

My Amendment 20 looks at health inequalities in urban areas and requests a strategy and an annual report. Impact on Urban Health, which is part of Guy’s & St Thomas’ Foundation, recently reported its State of Urban Health research and found that preventable mortality is 2.7 times higher in the most deprived urban neighbourhoods in England than in the least deprived. Urban areas also face some of England’s starkest health inequalities, with people living just streets apart experiencing significant differences in health. You have only to look over the river to the London Borough of Lambeth, where Impact on Urban Health is based: females who live just over a mile apart face an eight-year gap in life expectancy. As we have heard, these inequalities are driven by unfair and avoidable differences in everyday environments. These include exposure to air pollution, differences in housing quality and access to healthy, affordable food. I pulled this area out for specific attention: rather like the coastal communities amendment, it needs specific action.

My noble friend Baroness Tyler spoke strongly to Amendment 18, which would require a cross-government health inequality strategy and subsequent annual reports to Parliament on progress. That would focus minds and energy across government and would address the key point from the Health and Social Care Select Committee, as well as many of our suggestions in amendments and today’s debate.

If we are serious about narrowing the gap in healthy life expectancy and giving everyone the opportunity to live a healthier life, then action on the wider determinants of health and tackling health inequalities must sit at the heart of the Bill, not at its margins. I look forward to hearing the Minister’s response.

[Baroness Cash (Con)]

My Lords, I begin by thanking all noble Lords who tabled amendments in this important group and for the high quality of debate. At this time in the evening, it falls to me to be as brief as possible. As the quality of debate and the points made have been so thorough, I will try not to repeat anything.

We are all very much agreed: from these Benches, we have heard from the noble Lord, Lord Lansley, from the noble Baroness, Lady Manzoor, and from the noble Baroness, Lady Hodgson. We care a great deal about the inequalities in health outcomes in this country, but I am very grateful to the noble Baronesses, Lady Gerada and Lady Royall, for drawing the distinction between healthcare inequalities and health inequalities. It is important, and it is important for the purpose of the Bill and the duties that ought to be placed on the Secretary of State for Health.

It is incredibly challenging and painful to hear the data regarding ongoing inequalities. We know, of course, that healthcare is not the reason why it is in that state. The factors that play a part sit in different departments, which is why these Benches welcome the amendments which ask for a strategy. I hope that the Minister will consider joining up some of the significant work being done by the Government in the Fonagy review and the Milburn review to look at all these issues together.

It would be helpful to hear from the Minister about the specific actions the Secretary of State would be expected to undertake to ensure the duty as it is currently drafted, and how Parliament would be able to assess those decisions. We have heard from the noble Lord, Lord Lansley, about how we might improve on the current legislation, and it is important that we hear how that might be done. The inequalities in general practice are significant and challenging, and I look forward to hearing from the Minister about the Government’s plans to address them, such as through incentives to serve in different areas, targeted work plans and ensuring that enough training, development and recruitment is going on in those areas. I hope that all these issues will be subject to consideration by the Minister.

We cannot expect to reduce health inequalities without addressing these disparities in primary care. We look forward to hearing what might be done and what might be included in this Bill to do that. In the end, we must judge success by whether patients have access to the healthcare needed at the point of delivery. I look forward to the Minister’s response.