Health Bill

Debate between Lord Mawson and Baroness Bennett of Manor Castle

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.

English Devolution and Community Empowerment Bill

Debate between Lord Mawson and Baroness Bennett of Manor Castle

Committee stage
Tuesday 20th January 2026 Grand Committee

[Lord Mawson (CB)]

My Lords, in this discussion, there is a lot of confusion between what I call the two Ds: democracy and delivery. I have spent over 40 years working in East End housing estates. Around the time I first arrived, I sat in a room with a youth worker, who asked a group of young people, “What do you want to do?” They said, “Well, miss, we want to go to Walton-on-the-Naze”—which is a seaside resort in Essex—“and we want to go ice-skating and horse-riding”. So I got on an Empress Coach with this youth worker and all these young people, and we did those three things. Then a year later, I returned to the same room with the same well-meaning youth worker, who asked again, “What do you want to do?” They said, “Well, miss, we would like to go to Walton-on-the-Naze and horse-riding and ice-skating”. I said to the youth worker, “You’ve been to university, you’ve been to Australia and you’ve travelled around the world. Why are you asking these young people this ridiculous question?” She said, “This is democracy. This is giving them a real choice”. I said, “Really? Why don’t you suggest we’ll take them across the Sinai Desert in six months’ time?” She replied, “Don’t be ridiculous. They’ve never heard of the Sinai Desert”—precisely.

With a business partner, we ended up taking 200 of those young people, in a programme we developed, across the Sinai Desert with the Bedouin. We climbed Mount Sinai and had an amazing experience. When these bright, sharp, entrepreneurial young people from East End housing estates came back, they raised all sorts of interesting questions. One of them, called Darren, wanted to go off to New York—which he did; he then developed an amazing piece of youth work, which was very entrepreneurial and which the Princess of Wales recently visited.

In the very early days in Bromley-by-Bow, we began to embrace an entrepreneurial programme which was created with local people, including local young people. Some 97 businesses have been involved in that over the last 10 or 12 years. Over the years in Bromley-by-Bow, we must have hosted more than 70 Government Ministers, but I fear that we are still asking the same question in many of these processes. With this kind of legislation, because the granular detail is not understood, I fear that we will spend a lot of time with large infrastructure asking people what they want and where they want to go, without thinking about how we really empower a community, particularly a poor community. That is about jobs and work and, in our experience, about helping them build businesses and enterprises and lifting the game.

I agree that community engagement is really important, but so is the granular detail of how you do it, what it means in practice and how you generate learning-by-doing cultures on the ground in some of our poorest communities. If we do not start to do that, I fear that, once again—I must be on my 14th Government now—we will have some restructuring. We will use all these very fine words, but we will be back in that room with those young people asking them what they want, with no clarity about democracy and delivery. I have found with East Enders that they are interested more in delivery than in talk—that when you promise things, you actually do them, and you transform the opportunities for their children. That will not happen unless we get more into the granularity and create learning-by-doing entrepreneurial cultures. That is what empowerment looks like.

[Baroness Bennett of Manor Castle (GP)]

My Lords, in following the noble Lord, Lord Mawson, I feel the need to stress that we should not write off deliberative democracy, where people can access information and ideas and come together to reach new conclusions. Let us also stress that the economy—businesses and jobs—is one part of a much larger whole that is the community. Our society needs resources, education, time and health, so a simplistic, one-directional look at what our communities need will not answer our issues.

It is a great pleasure to take part in this debate with the noble Lord, Lord Lansley, who made some very telling points about how this is a seriously half-baked Bill. Your Lordships’ Committee is going to have to add quite a bit of heat to get it anything like ready for the table. I declare my position as a vice-president of the Local Government Association and of the National Association of Local Councils. I too wish the noble Baroness, Lady Pinnock, well and hope that we can see her back soon.

I start with the noble Baroness’s Amendment 95, as it demonstrates why we need many of the amendments in this group. It sets out in clear terms that the role of local government is to provide “democratic, place-based leadership” and it should not be

“solely a delivery arm of central government”.

Increasingly, that is what local government has been forced into being through the decades-long power grab by Westminster, accompanied by swingeing austerity that has left councils unable to carry out pretty well anything but their statutory responsibilities, which are of course determined by Westminster. That is a major driver of the extremely high disillusionment with politics and why the slogan “Take back control” was so popular in 2016.

I set all that out because my Amendment 9 seeks to add to the list of areas of competence. Most of the amendments in this group, as well as Amendment 95, would take the Government in the direction they say they want this Bill to go. I will focus on Amendment 9, but, regarding Amendment 8 from the noble Lord, Lord Lansley, on community engagement and empowerment, I have a lot of later amendments on this which are not necessarily contradictory but potentially complementary. I also support the community energy amendment from the noble Lord, Lord Ravensdale. Last night in the Chamber, I spoke about community energy; we are just not seeing the driving force that we need to bring renewables to local communities, which surely has to be a crucial part of the areas of competence of the new strategic authorities.

My Amendment 9 addresses food security and poverty. In terms of local food production, according to a recent report from the CPRE, 1,7 00 farms have disappeared around the edges of towns and cities since 2010. We have seen those peri-urban areas stop being food-producing areas when they should be at the centre of local food systems. We have seen a massive cut in the number of county farms; according to figures from 2019, over a couple of decades they have gone from 426,000 acres to about 200,000 acres. We have seen councils’ control over local food systems hacked away.

We know—this is why poverty and food fit together very well—that we have enormous spatial inequalities, arguably the highest in the OECD. That has been increasing over three decades. There is an understandable feeling in Cumbria, Cornwall, Northumberland and north Devon that Westminster does not understand their poverty problem or the reality of their lives. They are right. We cannot fix the problems of each of those places by making one rule from Westminster; tackling poverty in those places has to be a local responsibility, with power and, importantly, resources to go with it. We have been through regional development agencies, local enterprise partnerships, town groups and the wildly unpopular investment zones. There has been a huge democratic deficit in all those systems, and they all have failed.

I draw on two reports from the Food, Farming and Countryside Commission. The first is The False Economy of Big Food and the Case for a New Food Economy, which focuses on how what is colloquially known as “big food”—large centralised systems—is making us sick. It is the first report I have seen to have calculated the estimated total cost of our broken food system: £268 billion. A lot of that is the costs of healthcare, welfare support, social care and loss of productivity, all of which are having to be met by local authorities. Those are the costs—surely we need to put the solution and a reduction of those costs together.

We have lots to do here in Westminster. We have an extremely uneven playing field with a handful of big supermarkets and big food manufacturers entirely dominating the markets, throwing their weight around against local communities and farmers. Westminster needs to act, but how are we going to fill in the gaps? What are we going to put in all these different communities up and down the land? There is no one answer. Westminster does not have the answers.

I stress that about 22% of people in the UK are in food poverty. That means people who have a limited opportunity to feed themselves well, often relying on food banks, et cetera. UKRI is funding the Food Systems Equality project, involving systems in local communities to ensure healthy, sustainable food that reflects cultural preferences. We have recognition from one arm of government that the solution to our food issues has to be local—that is what UKRI is doing—but we have to put the power into local and strategic authorities to deal with that.

I pick one example of where something great is happening. An organisation called Growing Kent & Medway is an inspiring effort to create healthy and sustainable food systems in what has traditionally been the garden of England. It is place based, with a huge number of small independent businesses. I have tasted some great cheese and cider here in the House when they have come to visit us. But if we are going to have those kinds of systems all around the country in each area, they have to be supported by the strategic authorities.

Finally, I bring together food and poverty issues, including local food security in the UK. There is an interesting piece of work by the Royal Geographical Society, which carried out a visualisation of what food insecurity looks like in different parts of the country. It is useful to have this as a map, because you can see what different colours come out on the map showing the difference in different places. Food insecurity is variable across the country because of the levels of poverty, but the way in which people’s foodscapes are configured are different in different places. There is no way in which Westminster can find the solution for each place, because the solution in each place is different. There is nothing more fundamental for government to ensure that people are fed, but the Government in Westminster have to let go and let local communities find their own solutions.