English Devolution and Community Empowerment Bill

Debate between Lord Hunt of Kings Heath and Lord Mawson

Committee stage
Wednesday 4th February 2026 Grand Committee

[Lord Hunt of Kings Heath (Lab)]

We also have a terrible risk-averse culture among regulators in this country, which we need to tackle as well—but I really rose to support the amendment of the noble Baroness, Lady Royall. I have a later Clause 53 stand part notice, which partly covers the same ground.

Nye Bevan is a great hero of mine. He founded the NHS, but he made one mistake. He beat Morrison in Cabinet in 1947 in terms of the role of local government. Morrison of course had been leader of the London County Council, which, pre-war, had certainly been the largest hospital authority in the world. He argued that local government should be at the centre of the National Health Service. That was rejected, which was a great pity.

I have always believed that local government should play a much larger role, not just in health service provision, but also in health as a whole. My noble friend illustrated why that is important. She mentioned the Health Foundation’s report, which is stark in making clear that health outcomes in the UK are falling far behind those in other countries now. The country that we are most aligned with now is the US, whose health outcomes are pretty disastrous.

We know that we need a co-ordinated, system-wide approach, but what we have is fragmentation. The health service is outwith a lot of the discussions that noble Lords have been having in this Committee. It is very centrally driven. I had some happy years driving it from the centre, but I have concluded that it just does not work like that. We have seriously got to devolve. Local government deals with so many issues that relate to poor health, including transport, low incomes and poor-quality housing—all the things that noble Lords have been discussing. What I am doing, basically, is encouraging my noble friend the Minister to say that her department recognises that it has a bigger role to play in health than it may think.

Clause 44 is welcome. What we are trying to do is urge the Minister’s department to be as ambitious as possible and to do everything that it can to ensure that local government as a whole takes advantage of this. Mr Osborne’s agreement with the leader of Manchester City Council and its chief executive—in 2014 or 2015, I think—led to Devo Manc, which embraced health; it was the responsibility of the combined authorities rather than the mayor. There is enough evidence there to suggest that this is a good thing and that we need to build on it. My disappointment is that nothing has happened since then. The moment Mr Osborne left, no one in government was interested any more. I hope that we can resurrect it and say to local government, “We’re not going to improve our health without you being really important partners in this”.

[Lord Mawson (CB)]

My Lords, I, too, support the amendment in the name of the noble Baroness, Lady Royall, as well as what the noble Lord, Lord Hunt of Kings Heath, has just shared with us.

Earlier, I mentioned “learning by doing” cultures. What do they actually look like? We have been engaging in depth in east London for 42 years. We have pioneered a lot of the things that we now take for granted across the country in parts of the health service, including social prescribing. We have the long view. We spent time looking up the telescope, not down the telescope from government. When you engage in a local community in depth, you soon start to discover that health and wealth are absolutely connected—they are fundamental —yet the siloed systems of the state absolutely miss what all of this might mean and the opportunities that are there in practice.

The Bromley by Bow Centre, which I founded and of which I am now president, has pioneered wide-ranging approaches to these precise issues over the years. Today, we are responsible for 55,000 patients and we have built 97 businesses with local people. If they were here, our integrated health team would tell you that, on a vulnerable housing estate in the East End of London, getting a job has more of an impact on your health than anything that doctors can do in our health centre. All of them would tell noble Lords this. Yet, despite hosting 70 Government Ministers from different parties coming to see us over the past 30-odd years, when we share all this, they all say, “Yes, yes”, then go away. Nothing changes. In Bromley-by-Bow, we are still grappling with 62 different funding sources coming from the Treasury, all of which go down into different silos. We then spend a lot of money, with our staff, on putting things together around the same families. It is ludicrous. I share this with noble Lords: lessons are not being learned. In my view, the fundamental question that is being asked in this amendment is absolutely critical.

This Government are starting to talk about prevention and getting upstream. I agree with all of that but, if you talk to our GPs and our team—we have 2,000 visitors a year, from all over the country, looking at our work—they will tell you that the jury is out on whether this Government are serious about joining the dots around these issues. We will go not on what they say but on what they do. As far as we can see, at the moment there is little evidence that these dots are being joined up, but, if the Government get interested in practice, there is a great opportunity for this Administration and future Administrations coming down the line. This is not a party-political matter; it is a matter for us all and for the health of the nation.

In the 1990s, we realised, through practice actually, that the only way to gain scale with these kinds of issues is to start to partner with the private sector. We took these relationships seriously and today, both in east London and in a programme I lead nationally, we work with the private sector around place-making, and I declare my interests. The private sector is also concerned and interested in these questions. People in the private sector have children and families. Get to know them, dig under the carpet and create learning-by-doing cultures with them, and you will find opportunities to take these kinds of questions to scale. I support the amendment from the noble Baroness, Lady Royall, but I hope that we will move beyond amendments and yet more talk into practice and detail and get curious about what this actually looks like for local people.

--- Later in debate ---

[Lord Hunt of Kings Heath (Lab)]

It is interesting that at the moment the Government are trying to get the NHS to have an additional allocation to community health services in the planning guidelines. But all indications are that it is not happening, because the integrated care boards are saying that they have to protect acute services first. So community health services are not getting real additional funding. Before 1974, community health was of course run by local government and, with the suggestion to take it out again, I am beginning to wonder whether we do not need to be much more imaginative—basically to ring-fence resources.

[Lord Mawson (CB)]

My Lords, I absolutely feel the pain of the noble Baroness, because we also feel the pain from the other end of the telescope. It is really difficult, and a lot of these systems are profoundly broken. However, this is an opportunity for this Government. The reason why practitioners like me are suggesting that the Government need to create learning-by-doing innovation platforms at place, in real communities, is because that is where the social sector, GPs, the local authority and the NHS can come together to do this stuff and then really learn the practical lessons. That is the only way; it is not through academic papers at 60,000 feet or policy people who have never built anything. It is about practice. Through practice, you will learn where the real blockages are, and what you then need to do is share the lessons learned. Until we get to that place and learn from the micro, I fear that we will keep talking and very little will change.