Levelling-up and Regeneration Bill

Debate between Lord Best and Lord Bishop of Leeds

Committee stage
Wednesday 22nd February 2023 Lords Chamber

[Lord Best (CB)]

My Lords, I shall speak to Amendment 15 in the names of the right reverend Prelate the Bishop of London, the noble Baronesses, Lady Hayman of Ullock and Lady Watkins of Tavistock, and me. For this stage of the Bill, I draw attention to my housing and planning interests as in the register, including as a vice-president of the Local Government Association, vice-president of the Town and Country Planning Association and president of the Sustainable Energy Association.

The right reverend Prelate the Bishop of London is not able to be with us on this Ash Wednesday, but I know she feels deeply about this issue, not least from her distinguished career within the health service. I hope that I can cover some of the points that she wanted to make, and I know the right reverend Prelate the Bishop of Leeds will join in the debate.

Amendment 15 would ensure that health disparities are included in the Government’s levelling-up missions by getting this issue into the Bill. Improving public health and reducing health inequalities was a centrepiece of the original levelling-up White Paper. Two of the original missions, seven and eight, were aimed respectively at covering the gap in healthy life expectancy between localities and addressing determinants of mental and physical ill health, but these ambitions do not feature in the Bill. Ominously, it now seems that the promised health disparities White Paper may not see the light of day. There seem to be delays, too, in producing strategies for tackling the so-called obesity epidemic and for smoking reduction.

However, health inequalities in the UK have grown worse over the past decade after centuries of increased healthy life expectancy. Gaps have widened: the Inequalities in Health Alliance of 155 member bodies, convened by the Royal College of Physicians, notes that there is now a 19-year gap in healthy life expectancy between the least and the most deprived communities, and health inequalities cost the country £31 billion to £33 billion a year.

I declare an interest as the chair of the Oxford University Commission on Creating Healthy Cities, which reported last year. We concluded that, if central and local government gave priority to achieving better outcomes for physical and mental health, they would simultaneously address wider inequalities in society, improve productivity, support efforts to tackle climate change, and reduce the escalating costs of the NHS and social care. The Oxford study, driven by Kellogg College’s Global Centre on Healthcare and Urbanisation and the Prince’s Foundation, recommends that health creation should be the key focus of efforts to level up. Our commission supported the Government’s White Paper and its health objectives, and these deserve to be incorporated into the legislation before us. The whole levelling-up agenda can be a massive contributor to improvements in health and well-being.

This amendment is a necessary precursor to later amendments that link specific policy measures for the built environment—for planning, housing, transport and the environment—to the core issue of health. These important amendments would be greatly assisted by a backdrop of the Bill having a clear focus on health inequalities as one of its key missions. This would match advances in Scotland and Wales, where the emphasis on the health dimension in public policy and guidance has been strengthened over recent years.

Finally, in support of the right reverend Prelate’s amendment, I add that using health as the touchstone for levelling-up policies increases wider understanding and public support for the varied local projects that will follow enactment of the Bill. What assurances can the Minister give that we will see a focus on health, and specifically on health inequalities, in the levelling-up missions? What can the Minister tell us about the missing health disparities White Paper? I support the amendment.

[The Lord Bishop of Leeds]

My Lords, at Second Reading, I remember applauding, broadly speaking, the ambitions of the White Paper. However, I share the concerns of the right reverend Prelate the Bishop of London, who of course brings to this much more experience than I do.

I am pleased that, already, the noble Baroness, Lady Hayman, has alluded to the interconnectivity of all these different missions; they cannot be seen in silos or in isolation. For example, if you have children who are turning up at school unfed or living in poor housing, you can try teaching them what you will but it may not be very successful, and that has an impact not only on individuals but on communities and their flourishing.

I will speak to Amendment 15, tabled by the right reverend Prelate the Bishop of London, and briefly to Amendments 7, 30 and 31. Health disparities require discrete attention in the Bill. It is not an optional extra. The Bill as it stands states the missions but does not provide mechanisms for action or accountability. How will we be able to measure whether they are effective or not? The right reverend Prelate the Bishop of London has said that, although assurances by the Minister are very welcome, they are not enough; they have to be backed up in the Bill with measurable implementation gauges.

Good health is key both to human—that is, individual—and social flourishing. As I said, we cannot separate out such things as housing, education, health, transport and so on as if we can solve one without having an impact on the other. However, there are inequalities between the regions in many of these areas. I speak from a context in the north: the whole of west Yorkshire, most of north Yorkshire—but do not tell the right reverend Primate the Archbishop of York that—a chunk of Lancashire, one slice of County Durham and a bit of south Yorkshire. The inequalities are serious. The economic squeeze, in the words of the right reverend Prelate the Bishop of London, is an incubator for inequalities, and we know the impact that inequality has across the board.

The White Paper rightly recognises the centrality of health to levelling up, but the actions by which this will be achieved could be argued to be lacking—and we certainly need long-term solutions and not quick fixes or slogans that sound good but do not lead to content. Can the Minister therefore offer assurances of the Government’s commitment to health within the levelling-up agenda in ways that can be measured and accountability upheld?