Levelling-up and Regeneration Bill

Baroness D'Souza Excerpts

Report stage
Tuesday 11th July 2023 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

I declare an interest in that I am vice-president of Marie Curie and co-chair of the Bevan Commission on health in Wales. I shall speak principally to Amendment 7 in this group, which is based on the previous amendment in Committee from the right reverend Prelate the Bishop of London, who is also a signatory to this amendment.

The levelling up White Paper, the precursor to the Bill, published in February 2022, identified that:

“One of the gravest inequalities faced by our most disadvantaged communities is poor health”.


Yet health disparities are not explicitly specified in the Bill and the health disparities White Paper has been scrapped, hence this amendment. In Committee the Minister stated that the Government are committed to working with the devolved Governments to reduce geographical disparities across the whole UK and to share evidence and lessons from across the country, learning what works and what does not. Today we have already heard the Minister re-emphasise this in summing up on previous amendments.

Levelling-up missions must address inequalities right across the life course, from cradle to grave. Tackling health inequalities is essential to improving the nation’s economic health as well as people’s well-being. Inequalities in life expectancy are the result of poor health literacy and those broad social determinants of chronic illness and poor health. The Bill purports to reduce geographic disparities using a range of mechanisms. There are marked regional differences in health outcomes across the nation; within and between regions, disparities are increasing.

The largest decreases in healthy life expectancy were seen in the most deprived 10% of neighbourhoods in the north-east. Between 2017 and 2019, healthy life expectancy at birth for women in the north-east of England was 59 years, 6.9 years less than for women in the south-east; for men, life expectancy was 5.9 years shorter. Alarmingly, ONS data showed that healthy life expectancy was around 19 years shorter in the most deprived compared with the least deprived areas of the nation. In these deprived areas, people had a more than threefold risk of dying from an avoidable cause. Before the pandemic, health inequalities were estimated to cost the UK £31 billion to £33 billion each year in lost productivity, £20 billion to £32 billion in lost tax revenue and higher benefit payments, and almost a fifth—£4.8 billion—of the total NHS budget.

The pandemic sharply exposed the real impact of health inequalities through excess mortality in some population groups, and exposed a number of related socioeconomic factors and regional conditions that exist across the life course. Poor housing, inadequate diet, including maternal malnutrition, and adverse childhood experiences have long-term consequences, including crises in adult life, greater need for NHS and social care support and poorer employment prospects. Living on a low income is a source of stress, and emerging neurological evidence suggests that this affects the way people make health-affecting choices, ranging from food to activity.

Poor-quality and overcrowded housing is associated with increased risk of cardiovascular and respiratory diseases, depression and anxiety. Access to good-quality green space improves physical and mental health and lessens obesity. Deprived inner-city areas have far less good-quality green space and higher atmospheric pollution. Unemployment is associated with lower healthy life expectancy and poorer physical and mental health, for unemployed individuals and their households. In 2019-20, employment rates in the least deprived decile were 81.5%, compared with 68.4% in the most deprived decile. Such unemployment damages the nation’s economy.

These health inequalities, starting in childhood, persist right through to the end of life, when social disadvantage is often exacerbated by regional disparities, leaving palliative care needs unmet, particularly for those 90,000 people who die in poverty and deprivation, and those in rural areas where a quarter of the population are aged over 65, unlike younger urban populations. In the UK, those living in poverty, particularly in the most deprived areas, are more likely to die in hospital than in the community and have more emergency hospital admissions in the final months of life. When they leave bereaved children, these young people have worse long-term outcomes in mental health, employability and so on.

The Bill could break the cycle for many if it truly focuses on the population rather than being diverted by commercial short-termism. This is not about taking away from some to give to others: levelling up must address overall well-being and health inequalities across the life course for us to be an economically stronger nation. Without this as a common thread and a foundation for all missions, attempts to level up will fail. I hope that I will get overwhelming reassurance from the Minister today, because otherwise I will be really tempted to test the opinion of the House on this important issue.

[Baroness D’Souza (CB)]

My Lords, I thank the noble Baroness, Lady Lister, for tabling this amendment, to which my name is attached. The stated intention of the Bill, reiterated many times by the Government in both Houses, is the moral duty to reduce economic, social and environmental disparities between and within different parts of the UK. I will make two points.

Levelling-up and Regeneration Bill

Baroness D'Souza Excerpts

Consideration of Commons amendments
Monday 23rd October 2023 Lords Chamber

[Baroness Lister of Burtersett (Lab)]

My Lords, I will speak to my Motion B1, under which Amendments 4C and 4D would amend government amendments 4A and 4B in lieu. I am grateful to the Government for going part of the way in meeting the concerns raised in the original amendments, which were supported by your Lordships’ House. The purpose of those amendments was to introduce levelling-up missions to address child poverty and health disparities throughout the life course. The latter was moved by the noble Baroness, Lady Finlay, who is unable to be here today, but we have agreed the amendments that I am proposing. Both amendments received strong support on Report, including from the right reverend Prelate the Bishop of Durham, who regrets that he cannot be in his place today.

I am grateful, too, to the noble Earl the Minister for the helpful meeting we had last week. I am only sorry that the noble Lady Baroness, Lady Scott, is still unable to be with us, and I send her my best wishes. I am, though, disappointed that the Government did not accept the compromise that we proposed—I emphasise that it was a compromise. This compromise no longer pushes for specific missions and it accepts the government amendments in lieu, but would add to them the words

“including child poverty, and health disparities throughout the life course”.

I think they are still necessary—indeed, essential.

In the Commons and today, Ministers have acknowledged that child poverty and health disparities are

“essential factors when deciding missions”.—[Official Report, Commons, 17/10/23; col. 182.]

The Government’s argument against our original amendments is that missions may need to evolve over time, so their details should not appear explicitly in the Bill. But does anyone in government really believe that child poverty and health inequalities will not continue to be essential factors in any levelling-up strategies for the foreseeable future?

Just this weekend, the president of the Royal College of Paediatrics and Child Health emphasised the importance of long-term action on child poverty and health inequalities in the context of the climate emergency. Earlier, the early years healthy development review and the Marmot review into health equity underlined the need for a long-term focus with regard to these issues. This amendment would help ensure such a focus, without introducing the kind of inflexibility that the Government are so frightened of.

Given the time constraints, I will not repeat the arguments we made on Report. Child poverty and health disparities are a terrible blot on our society. Child poverty damages childhood itself and children’s life chances. Health disparities diminish life chances and physical and mental well-being at every point of our lives from before the cradle to the grave. The reference to life expectancy is only one element of health disparities; it is not the whole story by any means. Action on both fronts should be seen as an economic and social investment in the future of our society and as key to any levelling-up missions.

Acceptance of our amendment by the Government would constitute recognition of the importance of child poverty and health disparities throughout the life course and help ensure that, whatever the future levelling-up missions, they take account of these essential factors in levelling up our country and improving the life chances of all its members. Unless the Government are willing, even at the last minute to accept this compromise—and I hope I can persuade the Minister to accept it—I give notice that I wish to test the opinion of the House at the appropriate time.

[Baroness D'Souza (CB)]

My Lords, I too speak to Amendments 4C and 4D in the name of the noble Baroness, Lady Lister. We are essentially discussing four non-contentious words: “throughout the life course”. The Government have gone out of their way to address most of the concerns expressed about the welfare of children, for which everyone is extremely grateful. However, it is puzzling why these four words continue to be resisted. We know that health disparities begin in pregnancy, even before birth, as the noble Baroness said, and continue until advanced old age. Surely any levelling-up Bill has to acknowledge that continuous investment at every stage will result in a healthier and more productive society. The Government argue that this is implicit in the Bill, but why not make it explicit in the Bill? I honestly fail to understand this reluctance on the part of the Government and, should the noble Baroness, Lady Lister, decide to press her Motion to a vote, I will follow her into the Lobby.

[Lord Foster of Bath (LD)]

My Lords, I shall speak briefly to Motion D, which relates to rural issues, and my concern about the absence of rural issues in the Bill. Indeed, at Second Reading I made reference to this issue and pointed out the enormous disparities between urban and rural communities. I gave a range of examples from the way in which, for instance, housing costs are higher and yet wages are lower, to that the cost of delivering services such as education, health and policing is higher, yet government funding is lower. There were many other examples. These disparities have been referred to in your Lordships’ House and the other place on many occasions over very many years. Indeed, proposals were made several years ago by the noble Lord, Lord Cameron of Dillington, and were responded to by the then Secretary of State, Liz Truss, who said:

“This Government … is committed … to ensuring the interests of rural communities and businesses are accounted for within our policies and programmes”.


More recently, I had the opportunity to chair your Lordships’ special Select Committee on the Rural Economy. Again, we made a number of proposals, in response to which the Government said:

“Without doubt, these distinct characteristics”


of rural areas

“must be recognised in policy making and the government believes that rural proofing is the best”

way of doing it.

The most recent handbook on how to carry out rural-proofing—the Government’s Rural Proofing: Practical Guidance to Consider the Outcomes of Policies in Rural Areas—makes it abundantly clear that the rural-proofing process must take place before the presentation of legislation for consideration in your Lordships’ House and the other place. Yet, looking through the Bill as it was presented to us, I saw an absence of any reference to the distinctive nature of rural communities and the differences between them and urban communities. I also saw no evidence that a rural-proofing process had been done in advance of the Bill being presented to us. So, with the support of the noble Lord, Lord Carrington, I proposed a couple of amendments.

The first said that, in developing the mission statements, the Government must have regard to the specific needs of rural communities. That has been rejected time after time at various stages in the passage of the Bill. However, as we have just heard from the Minister—I am enormously grateful to him for the meeting that we had to discuss this issue—the Government have now conceded that amendment. It is now to be included within the Motion brought forward by the Minister. Again, I am enormously grateful to him.

My second amendment proposed that evidence of rural-proofing should be presented to your Lordships’ House before the Bill is able to be enacted. That has been rejected and, as we have just heard from the Minister, it is to be rejected again. In his opening remarks, the Minister said that I need not be concerned because there is clear evidence that the Government have gone through a rural-proofing process in relation to all government legislation. I will not argue with the Minister, but I gently say to him that, when independent experts have looked at this matter—for instance, the Rural Services Network looked at the most recent government report on rural-proofing—they have made it absolutely clear that, in their view, there is no evidence of rural-proofing processes having been carried out. There are a lot of mentions of some good things that the Government are doing to support rural communities but not of a specific process having been carried out. The precise conclusion of the Rural Services Network was:

“Nowhere … is anything evidenced anywhere to show if these processes were followed”.


I will take the Minister’s word for it that he has been given total assurance that this procedure was adopted for the passage of the Bill. For that reason, I will not press and have not put down an amendment to repeat what my earlier amendment said. But it would be enormously helpful if, for the sake of those of us who are still somewhat sceptical, he could provide written evidence of the procedure having been carried out.

As I have said, I am enormously grateful that—through the amendment he has brought, repeating the one I originally proposed—we now have reference in the Bill that the specific needs of rural communities will be taken into account in drawing up the mission statements. I am enormously grateful for the work he did to ensure that this happened, so I end by once again expressing my thanks to the Minister.