Health Bill

Debate between Lord Mawson and Baroness Pidgeon

Committee stage
Wednesday 11th November 2026 Lords Chamber

[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.

Health Bill

Debate between Lord Mawson and Baroness Pidgeon

Committee stage
Wednesday 28th October 2026 Lords Chamber

[Lord Mawson (CB)]

My Lords, I found this an interesting debate, and I am sympathetic to the amendment of the noble Baroness, Lady Bennett, and particularly that of the noble Lord, Lord Patel, because he is right that very little is actually being learned. My colleagues and I have listened, over the years, to lots of conversations about health inequalities. When you spend your life in very challenging housing estates and see very little changing, you know about the distance between all the words and the practice.

That is why, many years ago, we decided to focus on practice and the doing of things, rather than the talking about things. We began to realise what every parent knows: that you only really learn by doing. When I started to work with GPs, originally in east London, they began by telling me that was how you became a GP. You saw one, you did one and then you taught one; it was a very practical matter. Businesses and entrepreneurs nowadays know that you learn by doing things. Yet in the state, which often feels so out of date in the NHS, there is no learning by doing culture. There is a learning by writing very fine reports, often at 60,000 feet, that seem very unengaged with practice.

Over the years, it has been interesting to observe what happened through practice. The Bromley-by-Bow model is well known, so I will not use it, but the noble Earl, Lord Howe, knows that I was also responsible for the transformation of a street following a murder and 10,000 illegal injections being given out in a housing estate. There were some terribly violent circumstances going on at the time. When I brought the first key people on the street together, all of them—the GP, the school and the housing association—were saying, “We cannot deal with this on our own. We need to do it together. These things are so interconnected”, and we built together the St Paul’s Way Transformation Project, which started with nothing and led to a new £40 million school, a £16 million health centre, 600 homes and now a new primary school.

We joined it up, and Professor Brian Cox and I led our 14th science summer school in June this year, with a masterclass at the end of it on quantum physics, for the children from the same housing estates. It is the same children and same families, and now they have one of the best performing schools in Tower Hamlets. The noble Earl, Lord Howe, helped us greatly at one key point with learning by doing, when he met the whole group—housing, health and education—when the NHS was getting in the way of us completing on the deal for the health centre. He was very helpful in enabling that to actually happen.

It was Duncan Selbie, the chief executive of Public Health England in 2015, who gave me £20 million and said, “Andrew, take this culture that you’ve been developing into the north of England”. We built 10 learning by doing innovation platforms in Rotherham, Bradford, Doncaster and Bootle, all of which were about bringing people together to learn about these matters. It was interesting that when I met the public health officials in each of these places, who were lovely people quoting all the same data that I had heard many times before, and said to them, “What are you actually going to do about that data?”, there was absolute silence. It was not their fault. They did not have the skills to know how to turn fine words into practice for some of the most challenging communities in this country.

It is my view that one of the things being missed in this moment is the serious need to get real about innovation and learning by doing. My colleagues and I—I declare my interests—are at the moment creating at place, on the ground, with local people and professionals, what we call these learning by doing innovation platforms, so that we bring together the actual GP, business person and local resident, and you begin to explore these issues together because in the modern world, health is everybody’s business. It is not just a matter for GPs. It is interconnected and we need to explore what that means.

My concern about where we are at the moment in discussing this Bill, which is a fantastic opportunity for this Government, and this country, to move into a form of health that is of this century and not last century, is that we are going to end up building a lot of biomedical boxes around this country that do not explore these interfaces in some of our most challenging communities. The noble Lord, Lord Patel, is right; we need to worry about why he is right and why things are not being learnt.

I finish with the thought that it is our experience over the years that, sadly, we have to say that, in so many respects, the NHS is not a learning organisation. We must have hosted 70 Government Ministers to our work over the years. They all come and say, “Wow, this is fantastic, we need to do more of it”. I can name the four who did anything practical about that, and the other 66 sit on a list in this pocket. This is not to do with bad people. It is about whether, as a nation, we are now going to get upstream into prevention and health creation and create a learning by doing environment in which we all learn together, and in which local people are part of all of that process.

[Baroness Pidgeon (LD)]

My Lords, this is a very important group of amendments, and it has been a really excellent debate. One of the most pressing issues facing us is the widening gap in health outcomes between different communities. Healthy life expectancy has fallen in recent years and the gap between the most and least deprived areas of England, as we have heard, now stands at almost 20 years.

The point made earlier by the noble Lord, Lord Crisp, when he talked about the role of the department being one of leadership for health across government, not just running the NHS, is really important as we approach this group of amendments. We have heard clearly that the current legislative framework places relatively weak duties on government to address these wider determinants of health and tackle inequalities.

The House of Commons Health and Social Care Select Committee, in its scrutiny of the Bill, called for a stronger focus on improving the nation’s health and tackling inequalities, emphasising the need for clearer accountability and a more robust approach to prevention across government. Many of the amendments in this group would help to achieve that aim by ensuring that reducing health inequalities becomes a central objective of health policy, and that progress is measured and reported transparently.

My noble friend Lady Walmsley’s amendments, spoken to by my noble friend Lady Tyler, and Amendment 7 from the noble Lord, Lord Patel, would strengthen the duty on the Secretary of State to take steps or action, rather than simply “have regard to”. That is really important. Amendment 14, tabled by the noble Lord, Lord Patel of Bradford, and supported by so many Members of the House today, would require the Secretary of State

“to have specific regard to reducing inequalities”

in coastal communities. The point has been made clearly about the added complexities for such communities, whether those are workforce related or in local service provision. Those are really important.

My Amendment 20 looks at health inequalities in urban areas and requests a strategy and an annual report. Impact on Urban Health, which is part of Guy’s & St Thomas’ Foundation, recently reported its State of Urban Health research and found that preventable mortality is 2.7 times higher in the most deprived urban neighbourhoods in England than in the least deprived. Urban areas also face some of England’s starkest health inequalities, with people living just streets apart experiencing significant differences in health. You have only to look over the river to the London Borough of Lambeth, where Impact on Urban Health is based: females who live just over a mile apart face an eight-year gap in life expectancy. As we have heard, these inequalities are driven by unfair and avoidable differences in everyday environments. These include exposure to air pollution, differences in housing quality and access to healthy, affordable food. I pulled this area out for specific attention: rather like the coastal communities amendment, it needs specific action.

My noble friend Baroness Tyler spoke strongly to Amendment 18, which would require a cross-government health inequality strategy and subsequent annual reports to Parliament on progress. That would focus minds and energy across government and would address the key point from the Health and Social Care Select Committee, as well as many of our suggestions in amendments and today’s debate.

If we are serious about narrowing the gap in healthy life expectancy and giving everyone the opportunity to live a healthier life, then action on the wider determinants of health and tackling health inequalities must sit at the heart of the Bill, not at its margins. I look forward to hearing the Minister’s response.