Health Bill

Lord Mawson Excerpts

Committee stage
Wednesday 11th November 2026 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

My Lords, I will speak very briefly to these two amendments. It is a great pleasure to follow the noble Baroness, Lady Hollins, who made some of the points that I intended to make. We really need to give people the chance to meaningfully participate and to be part of society. Good work may be one route to that, but it may not be suitable or available to everybody.

The noble Baroness said that there is a great deal of not-good work out there, and I will point to some figures that recently came out on the loss of autonomy across the entire workplace. In 1992, 62% of people said that they had a great deal of discretion over the task they conducted and how they organised their working day. In 2024, that figure was 34%—it very nearly halved. People are not getting a sense of agency and autonomy in their workplace. That is without me getting into, as the noble Baroness did, the issues of zero-hours contracts, inadequate wages, unpaid overtime, et cetera.

Having said that, Amendment 279QF has some very good elements. I particularly applaud proposed new subsection (3)(a), which states that

“the Secretary of State must consult … young people with lived experience of mental health conditions and of being out of education, employment or training, and their families and carers”—

nothing about us without us. It is crucial that it is there, but I respectfully suggest to the noble Lord, Lord Singh, that perhaps this would be better as a “good work and meaningful participation in society” amendment or something along those lines.

I am afraid that I respectfully disagree with Amendment 48 from the noble Baroness, Lady Coffey. I will be interested to hear what the Minister says about it. A basic principle of the NHS from the very start has been that healthcare is provided on the basis of need. Giving the Secretary of State a special duty to help get people back into work would take away from that basic fundamental principle. Not making it on the basis of need and seeking to use the NHS to serve the economy would be a disturbing change in principle that needs to be highlighted and questioned.

In introducing the amendment, the noble Baroness talked about prescribing a job. That terminology would be really frightening to many people. I have met people with serious mental health conditions—we know there are significant numbers of them, including people in the NEET category—who are not applying for benefits, stepping away from the system and not getting help because it is really frightening to them. We absolutely do not want them doing that with the health service. If the health service were seen as a place of fear or compulsion then that would be dangerous to their future health and well-being and, indeed, the future health and well-being of society.

[Lord Mawson (CB)]

My Lords, I welcome these two amendments because they encourage us to debate a very important matter—employment. I have said before that the GPs I work with would remind us that, in the very challenging communities in which they work, getting a job does more for people’s health than anything they can do as doctors. We have done lots of work in this space over the years in east London and we are now replicating that practice around the country. It is why people like me are encouraging the health service and the public sector to learn from science and business that you innovate and learn only by doing things, not by writing clever reports or academic documents at 60,000 feet. You actually have to engage.

For example, to pick up the point from the noble Baroness, Lady Bennett, we have been running for over 15 years, with Investec, a jobs and small business programme in east London. It has been enormously successful. We have built 97 businesses, or local people have, many of them with health, mental health and other complicated conditions. When you get into the granularity of all that and you watch people’s lives, you watch what happens to their children and their family when they get a job and how things actually change, it is an extraordinary thing, that journey. It is a journey, I feel, and that is why I have been challenging the direction of travel of this legislation and this Government, because I fear we are missing a serious opportunity. If it is true what Michael Marmot and some of us saying—we come to very similar numbers that 70% to 80% of the determinants of health are social and nothing to do with doctors—then we enter this space, which is really important.

I declare my interest: I am working on a 30-acre site in Surrey at the moment, with a school that has been in very difficult circumstances. In the middle of that, there is an old primary healthcare building stuck there, disconnected from the school. There is a college behind a fence over there, which is doing what the head teacher would describe as babysitting children. Is this really about employment or is it ticking boxes? You have a large piece of land where you could bring health, education and housing together in a very interesting environment. We are looking at that opportunity. There is a real opportunity there to build what this Government call a neighbourhood health centre.

I am into all that, but neighbourhood health centres in the modern world cannot be just about bringing biomedical people together in a building—a biomedical box. That is not taking seriously what this conversation is about. We need to build multidisciplinary teams. We got into employment, health and wealth seriously over the years. We have even done projects with eight year-olds on developing their business plan. It is really interesting what happens when you do that with children. It would be interesting to have the Minister’s response on this. There is an opportunity, with neighbourhood health centres, to innovate, do something seriously and pick up the strands of this discussion.

I suggest that the way we get beyond the concerns from the noble Baroness, Lady Bennett, is to create practical learning by doing cultures on the ground, because all that theoretical stuff then falls away as irrelevant. You get into people with names and addresses, you watch what happens as you bring business, entrepreneurs, health practitioners and teachers together on the ground, and you start to build multidisciplinary teams. Innovation and something rather different happens. It absolutely relates to what the noble Lord, Lord Singh, said. I have been involved, as has he, in mental health, because mental health is a really big issue in these communities. You begin to get into the detail of that and beyond the theory into practice. When you watch a young person or an adult move away from many years of dependency and drug use—much of that drug use, by the way, at great expense from the NHS—you watch them take on life and see what happens to their children and family, my goodness it is a great inspiration. My view is that that is what these neighbourhood health centres should be about is multidisciplinary teams, learning by doing and getting into the granularity of what this discussion is about.

[Lord Kamall (Con)]

My Lords, I am grateful to my noble friends Lady Coffey and Lord Singh of Solihull for their amendments, and, in fact, to all noble Lords who spoke. We know that ill health is an issue not only for individuals, families and the community. At the macro level, it is a principal driver of economic inactivity, with millions of people of working age not working because of long-term sickness. Recently, my noble friend Lord Howe and I met with a GP who wanted to share his experience. He said that he was told that 93% of all notes that GPs sign are sick notes, so only 7% were to return them to work. His suggestion was that maybe the GPs in those situations should be asking for a second opinion, because there is a clear imbalance going on.

For many, work provides more than an income. It offers independence, purpose, structure and social connection, and losing that connection due to ill health has wider consequences, as the noble Baroness, Lady Hollins, and the noble Lord, Lord Mawson, said. Both my noble friends said that we should think of employment not simply as a matter for the Department for Work and Pensions but as part of someone’s well-being. That was very well illustrated by the real-world example that my noble friend Lord Singh of Solihull gave from his experience as a psychiatrist.

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[Baroness in Waiting/Government Whip (Baroness Hyde of Bemerton) (Lab)]

My Lords, I thank the noble Lord for that warm welcome.

With permission, I will address Amendments 48 and 279QF together, which look at the very important relationship between health and work. I agree with the point made by the noble Lords, Lord Mawson and Lord Singh, and the noble Baronesses, Lady Hollins, Lady Bennett and Lady Coffey—possibly all noble Lords who have contributed today—that good work, and I say that advisedly, is good for health, which is why we are already taking action to address the relationship between work and health. I agree with the noble Lord, Lord Singh, that work and health are not competing interests. I agree with the noble Lord, Lord Kamall, that the responsibility for good health does not sit just within the DHSC.

We already have programmes that bring together health and employment support around the individual, including health and growth accelerators. We are already acting at scale. This month, WorkWell began its national rollout across every ICB in England, building on pilots that have already supported around 25,000 people. Backed by up to £259 million over three years, the expanded service could support up to 250,000 people with health conditions to stay in work—this goes to the point made by the noble Baroness, Lady Coffey—or return to work. The 10-year health plan is clear on the critical role that the health system has, alongside local partners, in addressing health-related economic inactivity, especially through prevention and early intervention, which the noble Lord, Lord Singh raised.

Sir Charlie Mayfield’s independent Keep Britain Working review, published a year ago, highlighted the scale of the problem of people falling out of work for reasons of ill health and disability, including mental health conditions, and the vital role employers can play in addressing this. Further, the Government are already taking forward the development of a better model of workplace health provision through the Keep Britain Working programme. This system is intended to improve access to support for employers of all sizes, including the small and medium-sized enterprises referred to by the noble Baroness, Lady Coffey, and will be supported by a robust, recognised BSI employer standard. We are testing reforms to the fit note process so that the system works much better for patients, employers and GPs. These are aimed at moving from administrative sickness certification to a service focused on getting people the support they need to stay in work or return sustainably.

Finally, we have commissioned the recent Fonagy review and the forthcoming independent Milburn review, given the importance that the Government place on the relationship between work and health. Alongside this, given that several noble Lords mentioned young people, the Government are investing £2.5 billion by 2029 into the youth guarantee and the growth and skills levy. This investment will support young people and create up to 500,000 opportunities to learn and earn.

We do not believe that additional statutory duties or reviews are the right approach here. We are happy to offer the noble Lord, Lord Singh, the noble Baronesses, Lady Coffey and Lady Hollins, and other contributors today a meeting with the officials working on the Keep Britain Working thread. The Government are already taking significant action in the health and work space, and I hope that noble Lords are reassured that the Government recognise the importance of this issue.

[Lord Mawson (CB)]

My Lords, this all sounds fine in theory, but people like me are nosy—we go and have a look under the carpet at what is happening, in detail, in the machinery. Often, this machinery means well but the structures and siloed systems prevent the kinds of relationships that need to happen in the modern world.

I will illustrate this. From 2015, for many years I led the Well North programme for Duncan Selbie, which has now evolved into a national programme. It is interesting to talk to the Well Doncaster programme, which the noble Baroness, Lady Armstrong, will be pleased to hear now has 34 staff and operates across Doncaster —it is a fantastic success story and some great things are happening there. But I was talking to one of our lead colleagues there just a few weeks ago, who was saying that, in Doncaster, the Pride in Place programme is completely disconnected from this programme. I am sharing this with the Minister because there is a desperate need to get under the carpet of these practical issues, otherwise we will say all these wonderful things but—I say this from experience—very little will change.

[Baroness Hyde of Bemerton (Lab)]

I thank the noble Lord for those points. I recall that I did not answer substantively his point on neighbourhood health, and the further point he has raised cuts to the heart of that. I am very optimistic, as a former lead member in a local authority and now a Minister in this place, about the opportunity of neighbourhood health. It is a great moment to get away from the model of a clinical box and viewpoint and work holistically across a wide range of services. Let us continue to look under that bonnet together, because we are driving at the same aim here: improved health for all our communities, outside the silo of DHSE.

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[Baroness Pidgeon (LD)]

My Lords, we have had a really good debate on this group of amendments. My Amendment 216 addresses one of the most persistent inequalities in our healthcare system: the growing number of communities that simply cannot access an NHS dentist. For too many people, finding an NHS dental appointment has become an impossible task, with entire areas effectively becoming dental deserts. Other amendments in this group are very much in the same place.

Amendment 216 would require the Secretary of State to establish a scheme specifically designed to tackle that problem, ensuring that integrated care boards can guarantee emergency access to NHS dentistry and provide free dental check-ups to children, mothers within one year of having given birth, pregnant women and low-income households. The amendment recognises the current state of access to NHS dentistry across the country, and that preventive care is better for patients and more cost-effective for the NHS than treating advanced dental disease later.

However, my amendment would go further by recognising the critical importance of dental health for patients facing serious medical treatment and guaranteeing dental appointments for those about to start chemotherapy or undergo transplant procedures. It would help ensure that necessary treatment was not delayed because of untreated dental problems and would support those patients at a time of great need.

In this debate, we have heard of how dentists are remunerated. My amendment would require the publication of a reformed dental contract before the scheme was introduced, because the current contractual arrangements have contributed significantly to the workforce shortages and access problems that we see today.

My amendment is practical and targeted at ending dental deserts, improving access to dental care and ensuring that NHS dentistry is once again available to the people who depend on it. The noble Lord, Lord Patel, and the noble Baroness, Lady Coffey, have given clear examples of the different needs of coastal and rural communities and the importance of access to transport for access to services, which too often gets forgotten in these debates.

The amendment from the noble Lord, Lord Hunt, to which I have added my name, would ensure the publication of an important, regular report on the state of NHS dentistry and a debate in Parliament, which would keep a focus on this issue. There is so much going on in the health space that this can easily get lost, which in some ways has led to the situation we are in today.

We mentioned children in our debate. More than for any other reason, children attend A&E because of tooth decay. That is extraordinary. We can talk, and we have talked, about how we are tackling the issue—we have programmes teaching children how to brush their teeth properly—but what are we doing in nurseries and other early care settings? Only 10 years or so ago, my son was in nursery. That nursery had an NHS dentist who came in every six months and did check-ups with the children, and you got a note sent home. Why are we not looking at some of that preventive work? This report would allow the wider debate that we have started today, as well as discussion of some of the other important points and links to other health issues. I hope the Minister will respond positively and pick up the issue of that regular report.

[Lord Mawson (CB)]

My Lords, I support the amendment from the noble Lord, Lord Hunt. I will share a practical experience. In Tower Hamlets, a large proportion of the residents are Bengali and eat betel nut, which produces all the symptoms and serious health impacts that the noble Lord, Lord Kakkar, has well described. I have previously mentioned the street we rebuilt following some very difficult health circumstances. We ended up building a health centre, a school, 600 homes, and now a primary school, and we joined it all up with a multidisciplinary team. When you bring the headteacher, the GP, the pharmacist and the housing practitioners together, you start to learn things about the community in which you are based, and we began to discover this serious health implication among the Bengali community.

Because we had a very good working relationship with Queen Mary University, which is up the road and which became a partner in this development, there was an opportunity to bring a dental school, with a brilliant professor of dentistry, on to the street. We could then connect it to the pharmacy, the school and the science programme—which we have been running for 14 years with Professor Brian Cox—and create a whole joined-up situation that would not only improve the dental health of people but, if we connected it properly into the school, might well produce more dentists. It would mean that, instead of the health centre being overwhelmed by these issues, the dentists could start to deal with patients and the detail of all this. My point is that, if we began to think of neighbourhood health centres not as a box but as a street and a campus, and of the connections between these things, it would begin to throw up interesting innovations and solutions to issues that arise particularly in places such as Tower Hamlets, which are very much to do with dentistry.

I have to say that this was one of our health failures, because all that was coming together; everyone was in favour of it, and the professor of dental health was brilliant, but it sadly fell because of the politics going on in the medical school. I am illustrating it because, if we create a culture on the ground in neighbourhoods and build the relationships, these kinds of innovations around these very serious issues, which deal with the very serious medical conditions that the noble Lord, Lord Kakkar, rightly described, can start to happen.