English Devolution and Community Empowerment Bill

Baroness Boycott Excerpts

Committee stage
Wednesday 4th February 2026 Grand Committee

[Baroness Freeman of Steventon (CB)]

My Lords, I rise to speak to Amendment 159, to which I have added my name, and a series of amendments in my name. I apologise to the Committee that they had to be put in individually for procedural reasons, but essentially they would add to the list in Clause 44, and they all have to be done twice because it appears twice. I hope to keep this as short as possible. As the noble Baroness, Lady Bennett, said, these amendments were all suggested by researchers into the determinants of health to bring the clause into closer alignment with current research on the subject, as well as definitions, such as those used by the World Health Organization.

Everyone is delighted to see Clause 44 because there is good evidence that structural changes without changes in resourcing can make measurable differences to people’s health. I hope I can delight the noble Baroness, Lady Griffin, further by picking on Manchester as another well-studied, brilliant example of the effects of devolution. The results showed higher life expectancy in the lower income areas, which researchers think are related to improved collaborations between different services rather than more money being spent. If this is a causal effect and can be replicated elsewhere, it would obviously be great, and it would be great to measure it. This is why the researchers want to get right the things being measured and being taken account of by a mayor.

This is where my little list comes in. First, it is important to take account of the right health outcomes. Researchers suggested the list of health outcomes in Amendment 159, which I did not prepare to speak about, but I think they are self-explanatory, so we can leave that there. The series of amendments in my name alter the list of determinants of these outcomes. They are things that we know might affect someone’s health, so we have to keep an eye on them. Some that are known from research are missing in the current draft of Clause 44. Amendment 167A would add the availability of housing to standards of housing in new Section 24A(5)(a) because homelessness and housing security, which are known to affect physical and mental health, would not technically fall under standards of housing.

Amendment 167B would add noise pollution as one of the environmental factors in new paragraph (b). It is well recognised by those who study public health that exposure to noise pollution can contribute to cardiovascular risks and poorer mental health, so we need to take it into account like we do other forms of pollution.

Amendment 167C would put educational opportunities and attainment alongside employment and earning prospects in new paragraph (c). In the WHO’s report, A Conceptual Framework for Action on the Social Determinants of Health, education is a key underlying structural determinant that can affect jobs, income and all the other downstream aspects. So improving access to educational opportunities is key to reducing inequalities, including in health.

Amendment 167D is more specific on the sorts of public services referred to in new paragraph (d), making it clear that they should include retail and health and leisure facilities—they can, therefore, include the negative effect of retailers of less healthy foods, for example, or the absence of active transport facilities—as well as education, employment and access to health and leisure facilities, encompassing all the key services that are known to shape people’s health.

Amendments 167E and 167F would modify new paragraph (e). As drafted, it is about the use of tobacco, alcohol and other lifestyle factors that may be harmful to health. Amendment 167F would explicitly add diet and physical activity as important determinants to be considered. Of course, we know how much these can positively or negatively affect health. Amendment 167E would therefore add “exposure to”, as well as “the use of”, to recognise that some people are passively exposed to not just tobacco but advertising for tobacco, alcohol and less healthy foods; this is a known determinant of health and driver of inequalities.

Finally, Amendment 167G would specify that

“any other matters that are determinants of life expectancy or the state of health of persons generally, other than genetic or biological factors”

should include

“social and structural conditions, including social class, gender, race, ethnicity and any other characteristics or forms of social inequality that influence exposure to advantage or disadvantage”.

That would better cover the remainder of other determinants of health that are well recognised and to which we would want mayors to have regard.

I hope that the Minister will consider the substance of these amendments because, although they are not professionally drafted, they are based on professional research in the field and, I think, get at exactly what the Government hope to achieve: a great step forward in public health.

[Baroness Boycott (CB)]

My Lords, I am very pleased to follow the noble Baroness, Lady Freeman. What I have to add is that my Amendments 160, 161, 163, 164, 165 and 169 would bring a more climate change-related and environmental aspect to the asks of the Government. As the noble Baronesses, Lady Freeman and Lady Bennett, said, we are really pleased that this is here; I very much feel that we can work together to build on it. Here, I note the work of Leeds University and the Yorkshire and Humber Climate Commission.

My first amendment is on energy. A 2023 European scoping review found that energy poverty and fuel poverty are significantly linked to cardiovascular and respiratory diseases, excess winter mortality and poor mental health, with older people and children among the most vulnerable. A 2022 UCL Institute of Health Equity report found the same facts. It impacts population health at a structural level. In addition, I stress the low-carbon part of this amendment. Since the introduction of the ULEZ in London, gas boilers have somehow managed to become the largest source of nitrous oxide pollution. Air quality is listed in the Bill, but it is important to emphasise the interlinked nature: one impacts on the other.

My second amendment is on water pollution. Recent storms have highlighted—in fact, we were talking about this last night—the number of learning hours lost because of the fact that schools are flooded. We are extremely vulnerable to this, and we have very poor flood defences in our schools. I will not bore the Committee at length about the state of our waterways—every Peer in the place has already done this; I expect a Bill in the next Session—but, between 2010 and 2022, there was a 60% rise in hospital admissions for waterborne diseases in England. This is serious, as they are associated with gastrointestinal illnesses and reproductive and developmental issues.

On resilience, excess heat affects deprived communities more than wealthy ones due to the quality of buildings. A simple thing such as having leafy streets provides proper cooling.

I included my third amendment, on participation in democracy, because studies have shown that increased community involvement can have a really positive impact on health. Personally, I am very excited that, from this month, the National Lottery will devote either 20% or 25% of its entire funding to community engagement, such as community gardening and things like that. It makes a great statement about what really matters to people.

On food and diet, I very much support Amendment 168 on advertising. We know how bad food deserts are and how access to healthy food really affects poorer communities. Last week, I raised the issue of PFAS in a debate on the schools Bill. That is a Defra issue, of course, but it is relevant here because one of the prominent forms of exposure comes through our diet, particularly heating food in a plastic container in a microwave; that is, I am afraid, what lower-income families end up doing—so there is a double whammy.

Amendment 169 proposes a duty relating to allotments and nature-rich spaces. Again, this is something I have talked about a lot. I know that it is difficult for councils to create allotments because they are forever spaces, in a sense, but it is not difficult for councils to grant the right to grow in their communities and to issue meanwhile leases, which is what we did with capital growth in London; we created 2,500 spaces that are still going on now. These really make a big difference to communities. As I say, I am very pleased that the National Lottery is going in this direction on funding, because it will work with the Government and make a substantial difference to people’s real, lived experience.

[Lord Hunt of Kings Heath (Lab)]

My Lords, Amendment 165A is in my name. It seeks to

“include wheelchair and community equipment provision in the list of ‘general health determinants’ that authorities need to have regard to as a cause of health inequality”.

My intention is to highlight to noble Lords that the provision of wheelchairs and community equipment for disabled people is, to put it bluntly, a disgrace. I urge the Government to look at the outcomes at the moment for those who depend on wheelchairs and disability equipment and, basically, to ensure that local authorities and the NHS play their part in putting things right.

As the Wheelchair Alliance has said, at the moment, there are no consistent national standards, there is no independent regulation and there are few clear paths for users seeking repairs, reporting faults or making complaints. As a result, many disabled people face long waiting times, delays in hospital discharge, loss of independence, social isolation and, tragically, avoidable deterioration in health and well-being. It is the same dismal picture with community equipment, embracing hoists, hospital beds, pressure-related mattresses, grab rails, bathing aids, harnesses and all of the other essential items that we need.

The All-Party Group for Access to Disability Equipment recently reported on the systemic crisis in this sector. Carers think that things are getting worse, and the system is inconsistent, underinvested, fragmented and lacking leadership. What is tragic is that this is easily sortable. I am convinced that, if we sorted this out, we would provide a better service at less cost, because the current system is just a complete and utter mess.

The reason why the Bill is suitable is because local authorities and integrated care boards share responsibility for community equipment. Wheelchair services and community equipment often reach the same individual; they should operate in tandem, but they are two distinct systems. In welcoming this very good clause, I would like an assurance that combined authorities, in collaboration with the NHS, will take their responsibilities in relation to wheelchair and community equipment services seriously.

The noble Baroness, Lady Scott, made an important point about the difficulties that local authorities sometimes have in working with the health service and in the release of budget. Here we have a situation where both types of authority spend money inefficiently. I am suggesting that we could provide a much better service. Either the quality will be much better or we will have consistent quality, at least; I do not think that it will cost a lot of extra money as well.