Poverty Reduction

Baroness Finlay of Llandaff Excerpts

Thursday 22nd February 2024 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords it is a very great pleasure to follow the excellent maiden speech of the right reverend Prelate the Bishop of Hereford, which demonstrates clearly his commitment to rural communities.

In fact, Hereford’s history with royalty goes back centuries. To go back in time, St Ethelbert, King of East Anglia, was murdered there by King Offa of Mercia—but I am glad there is now peace with the Welsh, and we welcome the right reverend Prelate’s input into Wales. He has important roles with our royalty. He took part in the Coronation, escorting Queen Camilla. He is head of the King’s Ecclesiastical Household and organises the royal chaplains in his role as the Clerk of the Closet. He has many interests, which include hedgehog preservation—which I am sure we all welcome—but the one that worries me is that he likes riding motorbikes. I have already spoken to him about that in my role as a doctor.

The right reverend Prelate’s background in technology and science and his long rural career are clearly bringing great insights into the problems affecting our rural communities, and we all look forward to hearing more from him.

I am glad the right reverend Prelate referred to some of his predecessors. In the 13th century, Bishop Thomas Cantilupe was excommunicated but died in Rome. His heart and bones were brought back to England, where the bones started to shed blood, and many miracles followed. The royal connection continued, as in 1349 King Edward III found himself cured on his way to the ceremony in which Thomas Cantilupe was decreed a saint.

The Mappa Mundi is of course well known. That great map of the world shows in one corner a little city sitting on the stumpy River Wye. Hereford is at once on the edge of the world and at the very heart of it, and now there sits our Bishop. As custodian of this treasure, the right reverend Prelate is working to regenerate our rural communities with clear passion. We cannot attribute to him that hurricanes hardly ever happen in Hereford, but we look forward to his further major contributions.

I turn to today’s debate, for which we must all thank the noble Lord, Lord Bird, for his tireless work to advocate for those who cannot speak for themselves—all those who try but are not heard. I tried to map which departments should be involved in this issue. After all, we have the Prime Minister’s Office and 24 ministerial departments, and 20 non-ministerial government departments. They work with 423 government agencies and other public bodies, 11 high-profile groups and 19 public corporations, quite apart from the devolved Administrations. Going through that list was a discipline in itself, as for each, one could identify how they could influence poverty reduction.

As the noble Lord, Lord Bird, told us clearly, it is all too easy to think in terms of money, but we must not forget poverty of opportunity, poverty of aspiration and emotional poverty, all of which have profound negative outcomes in terms of life chances and life expectancy. In the missions on levelling up we heard about health and well-being, housing and crime. Crime erodes social capital, discourages investment and job creation, and increases levels of anxiety and fear within a population, who then feel insecure and easily become entrenched in poverty. Crime particularly undermines the prospects for young people. It works against the aspirations that our education system tries to instil.

I had the privilege of being a member of the Times Health Commission, which took evidence widely. We heard that people in the poorest areas are dying earlier but they are also living a greater share of their lives in ill health, often unable to work. The impact of income on health is stark: the poorest women are unhealthy for more than a third of their lives, compared with 18% for the richest, and children born into the poorest fifth of families in the UK are nearly 13 times more likely to experience poor health and educational outcomes by age 17 than the richest quintile.

Sadly, this bears out nationally. Dr Julian Tudor-Hart’s inverse care law is the principle that the availability of good medical or social care tends to vary inversely with the need of the population served. That is a key issue in the debates about health inequality, and particularly in relation to prevention of ill health. Public health measures are particularly important because, to quote Sir John Bell, who instigated UK Biobank, the origins of illness begin decades before the majority of illnesses become evident.

Less than 20% of our health is determined by medical interventions; the vast majority is driven by wider social factors, including diet, smoking, housing, alcohol, air quality, education, poverty overall and working conditions. I remind the House that Bevan had been responsible for housing as well as health when he founded the NHS. As he wrote,

“financial anxiety in time of sickness is a serious hindrance to recovery, apart from its unnecessary cruelty”.

People’s homes, their jobs and communities influence health; hence, you need a whole-system approach for a healthier, more prosperous Britain. Town plans determine housing, open spaces, transport infrastructure—all are important.

The influence of work security was clearly demonstrated by my friend and colleague Dr Norman Beale, a GP in Calne, Wiltshire. He studied the local population around the time of the complete closure of the Harris pork pie factory. As a local GP, with the nearest hospital 17 miles away, his practice was the first port of call for Harris employees and their families. Not surprisingly, he found a significant increase in morbidity in the workers made redundant when the factory closed, and a significant morbidity in their families.

A very important and unforeseen finding was that two years before closure, when it became apparent that the economic futures of the workers and their families were not secure, there was a higher morbidity. It began then. This has implications for the Department for Work and Pensions. The threat of redundancy is a stress equal to, if not greater than, the actual event. As the right reverend Prelate the Bishop of Durham explained in his outstanding speech, extrapolation of Beale’s findings implies an increase in workload and cost for the National Health Service that is directly attributable to job insecurity and unemployment. That is a situation now facing our population in Port Talbot, south Wales.

Perhaps in line with my noble friend Lord Bird’s philosophy, we recently debated the Online Safety Act. I congratulate the Government on taking this forward, as there is now much to do to make the internet safer, protecting children and adults from online harms that lead to dangerous behaviours, suicide and self-harm, gambling and violence, and into poverty.

Professor Sir Michael Marmot’s extensive work on poverty has shown the devastating impact of poverty on life expectancy. For example, the gap between Stockton-on-Tees and Kensington and Chelsea exceeds 16 years—but there is hope. This has inspired some cities, such as Coventry, to become “Marmot cities” and actively tackle the multiple factors that lead to deprivation by engaging all departments across the different official and voluntary sector bodies, from local authorities to health service agencies. They are beginning to show improved outcomes. It is slow but it is reversing a trend.

We must not have poverty of ambition to improve the resilience of our population through a better start in life in physical and mental health. Our ambition must be to improve work and living conditions. We need the ambition to level up across all parts of policy and to climb out of the post-pandemic trough in which we now find ourselves.