Health Bill

Debate between Lord Mawson and Baroness Thornton

Committee stage
Wednesday 28th October 2026 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I do not intend, by and large, always to follow the noble Lord, Lord Lansley, if I make a remark to your Lordships’ House, and I will not go into the reasons for health inequalities, because they have been spoken to very adequately by the noble Lord, Lord Patel, and my noble friends Lady Royall, Lord Hunt and Lady Nargund. However, I want to say something about social care because, although the noble Lord, Lord Lansley, is quite right about public health and the need for prevention, none of this is going to work or be delivered—I make no apologies for saying this and I will keep saying it—including the 10-year plan and integrated care, unless we also address the issue of social care inequalities. As I am chair of the Social Care Institute for Excellence, the Committee would be expecting me to talk about that.

We recently did research, which has been published, about the inequities experienced by people who use social care. I thought it might be useful to remind the House what that said, because it will sound very familiar when we are talking about health inequalities. It was about people with lived experience, because our work in SCIE is based on people with lived experience, and co-production. It said:

“These policy and practice implications are reflected … by participants: a named point of contact to help them navigate the complex system … better continuity of carers to improve the quality of care and reduce the burden of having to explain one’s needs”,


as we hear time and again,

“clearer and more proactive information to ensure everybody is aware of their entitlements … investment in the workforce to encourage greater professionalism and retention … more consistent provision across areas to reduce the postcode lottery”.

We could be talking about the inequalities we have just been debating; the same applies in social care. The reassurance I seek from my noble friend the Minister is that that will be recognised as we go through this legislation.

[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.

Health and Care Bill

Debate between Lord Mawson and Baroness Thornton

Lords Hansard - Part 2 & Committee stage
Tuesday 18th January 2022 Lords Chamber

[Baroness Thornton (Lab)]

Might I have some clarification from the noble Lord, Lord Mawson? He and the noble Baroness, Lady Cumberlege, have referred to three amendments and I can see only one. I would be grateful if he could enlighten me on which the other two amendments are that we might be addressing in this debate.

[Lord Mawson (CB)]

My Lords, there is just one amendment in this debate. My other two come further on.

Localism Bill

Debate between Lord Mawson and Baroness Thornton

Thursday 7th July 2011 Lords Chamber

[Baroness Thornton]

My Lords, I shall speak also to Amendment 147A. I realise that we are moving to a sensitive part of the Bill about which noble Lords have already expressed various anxieties.

There are two things that I should like to raise at this time. I understand that the Government propose that a community group should have the first right of refusal not within the moratorium period but, rather, at the end of it when the community group would compete against others on the open market. That presents a real difficulty. We all want to avoid the bureaucracy that has been a big problem in Scotland. On the other hand, we do not want to find ourselves in a position where the new community right leads to a widespread loss of assets of community value. It is a question of balance that we need to explore.

For the assets of community value in public hands, I suggest that there should be a first right of refusal for community groups. I think we all believe that it is a reasonable presumption that, where assets of community value are already being applied for public benefit, the default position should be to retain that public benefit. Only if there is no community purchaser should the asset then go on the open market. Therefore, the first right of refusal in such a case would require the introduction of mechanisms. Based on experience to date, it is possible for local authorities, with support from the Asset Transfer Unit, to devise a sensible low-cost system to agree a sale price, decide between competing community bids if applicable and establish fair arbitration mechanisms.

For assets of community value in private hands, I think everybody accepts that the right of first refusal might not be the best way forward. Again, we do not want to go down the road that has been followed in Scotland. The desire to safeguard private interests, which we have already discussed, is already resulting in a level of procedure and regulation that could stifle community efforts in some cases. That is what leads us to the idea of a simple system in which a moratorium at least provides a window for any community group to prepare a bid, rather than any complex process that will tie the community up in red tape.

That brings me to the second amendment in this group, which deals with the moratorium period. I am not alone in suggesting that the period should be a minimum of six months, which could be extended if necessary. Our experience and that of community groups across the country is that even the most capable and well established community organisations certainly need more than three months to get themselves up to speed. It often takes from six months to a year to progress to the point of purchase. Therefore, we need to find a mechanism that means, when there is willingness on all sides, the process will not be stymied by a moratorium period that has a cut-off point. Instead, if there is agreement to proceed, the moratorium period should be flexible enough to allow that to happen. I beg to move.

[Lord Mawson]

I shall speak specifically to Amendment 147A. I notice that the noble Baroness, Lady Eaton, has now joined us in the Chamber. I assure noble Lords that the Bradfordians are not pulling the wagons around in this debate.

Six months seems to be a reasonable period. We live in a very bureaucratic world. If you are a small charity or a social enterprise, without all the back-up of a local authority to get your ducks in a row and achieve the necessary permission, it can take at least six months to move forward with land or buildings. One property that my colleagues and I have been working on with a very competent group of people has taken at least two years to get through planning and to reach a point where we can do the development. That is with even the support of local neighbours and a lot of people behind us. Six months is a reasonable period; all my experience tells me that it is about right.

The noble Lord, Lord Rogers of Riverside, who has great experience in this field, is no longer here but I know he would tell us that nowadays it takes a mini-miracle to build a building or get a development going. It is very difficult to get projects off the ground. We wonder sometimes why we are not hitting the housing targets. It is because, as the noble Lord, Lord Hodgson, reminds us, there is so much red tape and treacle that you have to swim through to make any of this work.

The real test for the Bill will be whether it will be easier for those of us who develop land and buildings, whether we are business or social entrepreneurs, to do so. Will this legislation make it easier for us to do this work, or harder? This is the real practical challenge for this piece of legislation.