Queen’s Speech

Lord Kakkar Excerpts

Wednesday 11th May 2022 Lords Chamber

[Lord Kakkar (CB)]

My Lords, I thank the Minister for the thoughtful way in which she has introduced this particular day of debate on the humble Address and, in so doing, declare my own interests as chairman of the King’s Fund and of the Office for Strategic Coordination of Health Research.

Her Majesty’s Government’s commitment to levelling up and the introduction of the Levelling-up and Regeneration Bill is, of course, broadly welcome, but there can be no more important manifestation of the inequalities that exist between different regions of the country and between different communities and populations than the inequalities in health outcomes that have so plagued the successful delivery of our National Health Service. Indeed, in the last Session of Parliament, Her Majesty’s Government introduced a new health Bill, which has now received Royal Assent, with the determination that there may be greater emphasis on local co-ordination for the delivery of healthcare. However, that emphasis has been principally on matters of health, of course, and engaging with local government, but not really providing sufficient definition with regard to how the most important determinants that drive inequalities in health outcomes—the social determinants of health—might be most appropriately addressed. Those are matters that fall outside the traditional delivery of healthcare and are questions that pertain to local communities and the delivery of local government, such as the provision of employment, housing and education, as three important examples.

So, in coming to consider the Levelling-up and Regeneration Bill, it is important for Her Majesty’s Government to ask themselves whether, in moving this important piece of legislation, they are doing everything they can to provide maximum opportunity to focus on health questions. These are vitally important for the local communities the Government are so determined to support and encourage. It is well recognised now that the difference in life span between the wealthiest and poorest communities in our country is some seven years, but, more shocking, the difference in healthy life expectancy—that life period without ill health—is 17 years, with the poorest communities having far more chronic ill health and dying earlier.

How might attention to the provision of healthcare and investment in local communities address this question? That is clear when it comes to investment in the health service, but beyond that there is the capacity to look at, for instance, the regeneration of the high street, which the noble Baroness mentioned, and to ask whether there might be imaginative ways, and indeed ways facilitated through legislation, to ensure that healthcare facilities are provided increasingly in the high street: that is, using real estate that has been previously neglected and abandoned for the provision of community-directed healthcare facilities or of ambulatory healthcare facilities —facilities that are closer to the populations, particularly those who live in inner cities and central to towns, who tend to have much more chronic ill health and would therefore be able to avail themselves more easily of those facilities. In investing in that fashion, one provides not only the opportunity for improved access to healthcare but the opportunity for regeneration, broadly, of the high street, with much more activity and therefore much of what has to be provided in out-of-town hospital facilities being present in the high street.

Beyond the opportunity to drive regeneration through investment in healthcare facilities, there is the important question of undertaking population health research in communities to understand their true needs and therefore to respond with interventions that will have the greatest impact on improving local health outcomes. In this regard, there is a greater need for local government and local authorities to participate in the health research agenda, something that does not happen effectively at the moment. This is an area where encouragement from government for cross-departmental engagement on these matters, beyond the Department of Health and Social Care, is critical.

Finally, there is the question of how investment in healthcare locally can drive the development of excellent employment opportunities. If provision is made for the training of local populations to participate in the health and care workforce, those populations should continue to be developed and encouraged over the duration of their professional careers. This would not only deal with important needs in local communities, but the upskilling of a population devoted to health and care, and ultimately the attraction of further investment and engagement with universities and other educational institutions, would provide the opportunity for broader investment in the life sciences ecosystem that will usually attend communities and institutions delivering high-quality healthcare.

This is an important opportunity for Her Majesty’s Government when considering the broader question of levelling up. It is not usually discussed as an element of the levelling-up agenda, but failing to use this important opportunity to bring together local government, to facilitate—indeed, to mandate—a focus on addressing social determinants of health, and to ensure that the planning system can provide the opportunity to create meaningful, local and locally focused healthcare facilities, would be critical.

In closing this part of the debate, I wonder whether the Minister might reflect on how Her Majesty’s Government can use their levelling-up agenda to address these issues.