King’s Speech

Baroness Jay of Paddington Excerpts

Thursday 9th November 2023 Lords Chamber

[Baroness Jay of Paddington (Lab)]

My Lords, I follow other noble Lords, in welcoming and supporting the measures to reduce smoking, but like the right reverend Prelate, I am most concerned this afternoon about the lack of any broad-based public health programmes in the gracious Speech. Public health, after all, is central to successful healthcare in this country and, indeed, to the overall health of the nation, yet it has been neglected for many years and is neglected again. I repeat my welcome for the tobacco products Bill, but one Bill does not create a strategy. In every area we look at, the need for a broad-based programme to meet the public health crisis we are facing is urgent. In every problem you look at—from obesity to sexual health, from children’s dentistry to disease caused by damp housing—the situation is getting worse and worse. At the same time, we have seen the capacity of the NHS fall. Sadly, it has become a struggling health sickness service, rather than a positive health service. If we want the NHS to be renewed and restored to its proper role, we must primarily focus on avoiding preventable disease and promoting healthy living through cross-government programmes.

At the Labour conference last month, the shadow Health Secretary, Wes Streeting, promised that a Labour Government would deliver a prevention-led revolution. He insisted that a broad revolution, putting prevention first, could be delivered through social, economic and environmental change. This, he said, must lead to less illness and therefore less pressure on the NHS. Now there is no doubt that achieving this type of change is complex, difficult, expensive and long term. But under the Conservative Government, many prevention initiatives have been greeted with the cliched expression, “a nanny state” calling for intervention in our private lives. I understand that even the new anti-smoking Bill, which has the Prime Minister's personal endorsement, has already been criticised by his own MPs on this basis.

In the last 13 years, many of the specialised institutions that focused on promoting good health have disappeared or been marginalised. The Government abolished Public Health England, which had a global reputation for its expertise and research. The grandly titled Office for Health Improvement and Disparities has been recently set up, but so far no grand practical statement of environmental activity has been announced. Today, many of the responsibilities for public health have been devolved to local authorities; at first sight that seems a good idea as so many services that can affect people’s general health are provided at a local level. However, the Treasury’s public health grant to local authorities has been reduced by a staggering 26% in the last years; not surprisingly, basic services have suffered badly or completely collapsed. Apart from the financial cutbacks, the connections between organisations commissioned by individual councils and the health service can be weak and can reduce vital capacity. Services have sometimes been outsourced to independent bodies, which do not have the necessary expertise to deliver them. This has been recently drawn to my attention in relation to HIV and other sexually transmitted infections. There has recently been an alarming increase in many of these infections, some of which are growing by as much as 50%. These must require medical care, which is often lacking in an outsourced clinic. For example, only half the clinics can now offer face-to-face appointments for individual advice and treatment—they simply cannot deliver good practice.

However, even if the Government have somewhat neglected the needs of good public health, it is encouraging to see the current level of parliamentary interest and engagement with these issues. The well-established All-Party Group on Health in all Policies has been able to broaden the discussion about reducing health inequalities and promoting healthy lives in ways that go way beyond traditional concerns about, for example, working conditions and safety. The Levelling-up and Regeneration Act 2023 could have been an opportunity to put some of these policies into legislation, specifically in the area of poor housing. There were several attempts to amend the Act in this way but all failed, although it must be remembered that the health effects of inadequate housing already cost the NHS about £1.4 billion a year. In this House, the noble Lord, Lord Crisp, with his vast experience in public health, pursued his amendment on healthy new homes to the point of ping-pong proceedings and still he did not succeed. In final exasperation he said:

“I have taken the key message that the Government do not want to … ensure that new homes and neighbourhoods promote health, safety and well-being. I think this is extraordinary.”—[Official Report, 23/10/23; col. 437.]


I must say that I agree with him.

Meanwhile, our very active Peers for the Planet organisation is urging an even broader approach to public health, which I support. It argues that the crises of climate change and threats to nature have a profound impact, and there are calls for the WHO to declare this a global health emergency. As far as the UK is concerned, the effects of higher temperatures have already been observed. In 2022, heat-related mortality in this country was up by as much as 42%, which is well over the five-year average. The very respected journal the Lancet has suggested that we should act immediately in this country on cleaner energy, improved air quality and access to green space. It is a vast agenda, but it should not be overwhelming. It needs a new clear strategic approach by the Government and resources to match. Given their record, I do not expect the present Government to give priority to this in the last months before a general election. On the other hand, the Labour Party has already published ambitious plans for its prevention and revolution in health. I am confident that there will be manifesto commitments on public health in all social policy. We can then have a programme that both improves health and renews the NHS. I look forward to discussing a new approach in the debate on the next gracious Speech.