King’s Speech

Lord Mawson Excerpts

Wednesday 20th May 2026 Lords Chamber

[Lord Mawson (CB)]

My Lords, in response to the gracious Speech, I want to focus on health. This Government’s policy to move more services out of hospitals and into local communities is the right direction of travel. However, NHS England’s neighbourhood health centre guidance deserves a clear-eyed response. After three decades working across primary care, grass-roots community regeneration and social enterprise, my colleagues and I at the Bromley by Bow Centre find ourselves holding two different views at the same time: real optimism about what this programme could become, and deep frustration about the journey and destination described in the current road map.

The Bromley by Bow Centre has been working in this space for 42 years. We built the first integrated working model of what we think the Government are proposing. We are now responsible for 55,000 patients on four sites in east London, and have grown, with our public and private sector partners, a national social business working on place-making projects across the country. I declare my interest. We have focused on practice in the micro because we know that the clues to the macro lie there.

The neighbourhood health centre programme signals a genuine institutional commitment to moving healthcare closer to communities. The ambition to create 250 centres by 2034, the multi-disciplinary model and the acknowledgement that health cannot be delivered by clinicians alone all point in the right direction. At its best, the NHC framework is an invitation. The problem is that it is written in the language of compliance, rather than liberation, and is simply not radical enough.

There is an implied acknowledgment that good health is driven principally by social factors, but there is an underpinning assumption that a successful NHC will be defined by how it more efficiently organises multidisciplinary teams in a single building, rather than how it might meaningfully pass the ownership of health resources into the hands of local communities. What the guidance gets right is the recognition that health is produced in communities, not just delivered by clinicians. The neighbourhood health centre framework could, if NHS England has the courage to allow it, become the vehicle through which a generation of community entrepreneurs—many of them GPs—finally get the platform, the estate and the institutional backing they have always lacked.

The Bromley by Bow Centre was an early example of what becomes possible when you refuse to draw hard boundaries between health, community, enterprise, the arts, green space and human connection. We were not unusual in our instinct; we were unusual in having the space and partners to act on it. NHCs could give many more organisations this same opportunity.

However, the case for flexibility is not simply ideological. We have known for decades that 80% of health outcomes are driven by social determinants. A programme that creates impressive buildings, staffed by excellent clinicians and allied professionals, but fails to address these upstream factors will make a marginal difference at best. The problem is that the guidance is shaped overwhelmingly by a statutory NHS-centric worldview.

The illustrative design briefs for new neighbourhood health centres capture this problem precisely: rooms with narrow purposes, square boxes, places for professionals who drink coffee, but no art-making spaces, no messy spaces and not a curved wall in sight, in buildings that one health colleague described as “prisons”. The consequence of this type of top-down thinking is a dominant multidisciplinary clinical model, with social factors treated as peripheral rather than foundational. These will be places to go for appointments, not places you belong to.

The omissions in the guidance are as telling. The creative arts are entirely absent, despite a substantial evidence base for their foundational and consistent role in good health outcomes. Social enterprise and business are also missing, despite some of the most innovative health-generating work in the UK being done in this space. On community ownership of assets, the words point to local power, but the structures point to central control. Green space and horticulture are a remarkable omission, given the evidence on their broad therapeutic and transformative value—ask the RHS. On funding for non-clinical services, social prescribing is promoted while its funding base is eroded and the resourcing of the non-statutory services that it refers into are being decimated.

Perhaps it is not too late. NHS England has a choice: it can insist on fidelity to the template and create 250 well-resourced and shiny MDT polyclinics that improve access to statutory services, or it can explicitly invite and resource flexible interpretation.

The modern health world is everybody’s business; it is no longer the private domain of the NHS and its clinicians. Such a model is totally financially unsustainable. The challenge for this Government is whether they will create a health landscape based on last-century thinking or a modern, entrepreneurial culture in which everybody plays their part. This is the big opportunity to truly join up government systems on the ground. Let us hope we do not miss it.