Health Bill

Debate between Lord Lansley and Baroness Lister of Burtersett

Committee stage
Wednesday 28th October 2026 Lords Chamber

[Baroness Lister of Burtersett (Lab)]

My Lords, I am honoured to follow my noble friend Lady Nargund. I have added my name to a number of the amendments in this group calling for a clear duty on the Secretary of State to take action to reduce health inequalities and produce a cross-government health inequalities strategy. I also support the other amendments on this theme, including that in in the name of the noble Baroness, Lady Bennett of Manor Castle. As we have heard, her amendment makes specific reference to inclusive health groups, including Gypsy, Roma, and Traveller communities, who experience some of the poorest health outcomes of any group in England, as the noble Baroness, Lady Jones of Moulsecoomb, spelled out.

As Just Fair points out, there is a right to health under the International Covenant on Economic, Social and Cultural Rights. In its 2025 concluding observations, the UN Committee on Economic, Social and Cultural Rights raised a number of concerns about the provision of health services in the UK, including inequalities in access to care, as we have heard about.

At Second Reading, I and a number of other noble Lords spoke in favour of a clear duty on the Secretary of State to tackle health inequalities and a cross-government health inequalities strategy that would underpin the preventive approach that the Government, rightly, initially favoured and, indeed, that the Chancellor referred to in his Budget speech today. Our interventions reflected calls from a wide range of health and other bodies, many of which support the Health Equals campaign to put tackling health inequalities on a statutory footing and to reboot the Government’s emphasis on a preventive approach. It also reflected the position of the Health and Social Care Committee in its scrutiny report on the Bill.

The Government themselves have emphasised the importance of addressing health inequalities in their child poverty strategy, as I pointed out at Second Reading. Indeed, the strategy declares that addressing healthcare inequality is at the heart of their health mission. Moreover, in September, the Minister for Women and Equalities, in announcing the establishment of a new class unit, described it as

“a pivotal step in embedding a focus on socio-economic inequality into the heart of government”,

as part of their drive to tackle entrenched inequality. Given all that Ministers have said about inequalities, I am puzzled as to why they seem so reluctant to translate this commitment to tackle entrenched inequality into a statutory duty in this key legislation.

In the Commons, Minister Smyth failed to give a convincing explanation as to how mere empowerment is more effective than a duty to address health inequalities, which she herself said remained a government priority. However, it might not be a priority for a future Government, so warm words are not enough. In the Second Reading debate in your Lordships’ House, my noble friend the Minister reiterated the Government’s commitment to working for greater equality but did not engage with the arguments put by a number of us and explain why a power is better than a duty to achieve this. I therefore hope that she has been able to reflect on what was said and on the growing pile of evidence on health inequalities, especially among children, some of which we have heard about today, and that she will be able to respond more positively and commit to bringing forward a government amendment on Report that meets the objectives of the various amendments debated today.

[Lord Lansley (Con)]

My Lords, I may be the first speaker not to have signed any of these amendments, but that does not mean that I do not agree with them; a great deal has been said with which I agree. The importance of this debate can hardly be overstated.

I just want to contribute one thought, which is that in taking all these issues and understanding how they relate to this Bill, we have to put it in the context of what is already in the National Health Service Act. I want very quickly to outline that.

The Bill before us is an improvement on what is in the NHS Act as far as the Secretary of State’s duties are concerned, because it extends the duty from equal access to healthcare services and facilities to seeking to reduce inequalities and securing equity in outcomes from healthcare services. That is what is in the Bill; I think that is a significant improvement. The Bill focuses at this point on what the National Health Service is doing to secure the prevention of illness and the promotion of successful treatment. It is not about the improvement of public health at that point.

The noble Baroness, Lady Tyler of Enfield, talked about the Bill transferring a duty to the Secretary of State. In fact, the NHS Act has the same duty on both the Secretary of State and NHS England: they are concurrent duties. Therefore, we are not transferring the duty; this is not part of a transfer from NHS England to the Secretary of State.

Under Section 2A of the NHS Act, the Secretary of State has a duty for the protection of public health, which are all those things to do with vaccination, immunisation, et cetera. Section 2B, which was inserted by the 2012 legislation, as my noble friend on the Front Bench will recall, inserted into the Act a duty as to the improvement of public health, and that is on both local authorities and the Secretary of State. It is not, I think, phrased as we would want it to be; more needs to be done to look at that.

I suggest—and this picks up the point made by the noble Baroness, Lady Royall of Blaisdon—that when we talk about wider determinants of health, we are looking at a strategy that relates not only to the Secretary of State—i.e. to the Government—but to local authorities, and she made that point very rightly. But it is in the NHS Act. Local authorities have a duty to improve public health in their area and take such appropriate steps as they can to achieve that, and the Secretary of State has such a duty to improve public health in Section 2B—unaffected, as I understand it, by this Bill. Therefore, when we come to look at it on Report, I hope that those who are thinking about how we might create the right strategy for the improvement of public health do not just think that it is done by attaching it to the responsibilities of the Secretary of State in relation to the NHS but also look at Section 2B.

Welfare Reform and Work Bill

Debate between Lord Lansley and Baroness Lister of Burtersett

Monday 21st December 2015 Lords Chamber

[Baroness Lister of Burtersett]

Perhaps I can explain. Unfortunately all the evidence shows that far too many people get stuck in low-paid work which does not take their children out of poverty. A very large proportion of children in poverty have a parent in work. One of the points made by the Joseph Rowntree Foundation against the cap is that, even in that minority of cases where the result has been for someone to move into work—it is a very small minority, as we have heard—the danger is that in the long term it is counterproductive because it pushes them into unsuitable, insecure and low-paid work.

[Lord Lansley]

I understand the point that the noble Baroness is making, but I am afraid that I do not agree with it, for two reasons. The first is by virtue of the other measures that this Government are taking in relation to availability of childcare, the further extension of personal tax allowances and the increase in the national minimum wage, leading to a national living wage. All of these enable people who are in work to achieve more of a living income through being in work. The second and most important reason is that work in itself changes the character of a household; it changes the character of people’s lives. Frankly, in the long run, it changes people’s employability.