English Devolution and Community Empowerment Bill

Debate between Baroness Freeman of Steventon and Lord Wilson of Sedgefield

Report stage
Thursday 26th March 2026 Lords Chamber

[Baroness Freeman of Steventon (CB)]

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.

[Lord Wilson of Sedgefield (Lab)]

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.