English Devolution and Community Empowerment Bill

Baroness Freeman of Steventon Excerpts

Thursday 26th March 2026 Lords Chamber

[Baroness Royall of Blaisdon (Lab)]

My Lords, I will speak to my Amendments 133 and 134. As we are aware, the UK’s health is fraying and unequal, with increasing numbers of people unable to work owing to poor health. Compared with other high-income countries, the UK now has one the lowest life expectancies and is among those with deepest health inequalities. This has avoidable and negative consequences for individuals, public services and the economy.

Addressing these inequalities requires action at regional level, where leaders have the powers to shape economic growth, create healthy places and reduce inequalities. This Bill provides a timely opportunity to embed health and health equity at the heart of devolved decision-making, and I warmly welcome Clause 44, which is a crucial lever for improving health and reducing health inequalities.

In Committee, I tabled amendments to strengthen this duty and the proposed local growth plans to ensure that all strategic authorities act consistently to improve health, reduce health inequalities and consider health while growing their local economies. My noble friend the Minister responded that she believes the duty as drafted

“will apply to all functions, including developing a local growth plan”.—[Official Report, 4/2/26; col. GC 613.]

However, the Government have not yet provided any detail on how this duty should be fulfilled or how strategic authorities will be held accountable for this. Without this detail, there is a real risk that inequalities will be worsened, with some strategic authorities taking significant action to improve health and others seeing the duty as a tick-box exercise.

To ensure that the duty is as successful as we and the Government want it to be, I have tabled amendments which would require the Government to report to Parliament on the implementation of the duty. I am grateful to the noble Lords, Lord Hunt of Kings Heath, Lord Bassam of Brighton and Lord Bichard, for their support.

The Government previously said that they will monitor the health duty, with Miatta Fahnbulleh, the Minister for Devolution, Faith and Communities, saying that

“we will continue to monitor how the new duty beds in and its impact across the country, so we can ensure that the intent is aligned with practice and delivery”.—[Official Report, Commons, English Devolution and Community Empowerment Bill Committee, 21/10/25; col. 358.]

These amendments would formalise the Government’s commitment, providing a mechanism to identify whether further support, guidance, resources or requirements are needed in the future. It would also provide a mechanism to support shared learning across strategic authorities.

The amendments focus on implementation and process rather than outcomes, given the time it takes to see shifts in health inequalities. Information could be collected with a light-touch approach of returns from strategic authorities covering actions taken, strategies produced, partnerships formed, et cetera, and desk research by civil servants. Without these amendments, there is a risk that the new health duty remains well intentioned but inconsistently applied across regions and will therefore fail to have any real impact on reducing health inequalities. This would be a significant missed opportunity to reverse worrying health trends. If the amendments are not acceptable, I hope that the Government will agree to guarantee strong guidance on this issue to ensure that the duty is properly implemented across all regions.

[Baroness Freeman of Steventon (CB)]

My Lords, I support these amendments. I spoke to Amendment 132 in Committee. I will not repeat what I said then, but I just want to say that the Minister said in Committee that the reason why the Government want to stick with their own wording on Clause 44—a clause that we all support very strongly—was that they did not want to be too prescriptive regarding what areas should be looking at as health determinants. However, if we do not reflect what is known about the determinants of health, we will not be able to set down what we need to measure to evaluate the success of Clause 44, which is so important and which the noble Baroness, Lady Royall, spoke about in connection with her amendments. I therefore urge the Government to look very carefully at these amendments to see whether some adjustments can be made that would make Clause 44 as strong as we all want it to be.

[Lord Wilson of Sedgefield (Lab)]

My Lords, I thank the noble Baronesses, Lady Scott and Lady Royall, for their amendments relating to the new health improvement and health inequalities duties. I also thank the noble Baroness, Lady Freeman, for her helpful contribution.

On Amendment 132, I stress our ambition to enable combined authorities and combined county authorities, which are the experts in their local areas, to take a broad view of the factors that shape health and drive health inequalities in their areas. The Bill illustrates a number of important health determinants to give clarity to our intent and indicate areas where authorities are likely to be able to act. It already includes standards of housing and matters of personal behaviour and lifestyle. It also explicitly allows for consideration of any other matters that affect life expectancy or the general state of health.

Setting out large numbers of individual determinants risks restricting flexibility, because it would imply that the specific determinants to be considered are only those which are set out in detail in the Bill. Indeed, the proposed amendment would have the effect of limiting the scope of “general health determinants.” It would set out a narrower list of general health determinants by removing the scope for combined authorities to consider

“any other matters that are determinants of life expectancy or the state of health of persons generally, other than genetic or biological factors”,

and focus instead only on matters of personal behaviour and lifestyle, rather than also considering wider public health and systemic matters which might determine life expectancy or the state of health of a person.

I am grateful to my noble friend Lady Royall for her Amendments 133 and 134. However, these amendments would add an unnecessary bureaucratic burden on combined and combined county authorities. The Secretary of State would be unable to make such an assessment without placing detailed reporting requirements on combined and combined county authorities. We want to shift power away from Whitehall and into the hands of those who know their communities best. The requirement for the Secretary of State to make an assessment of the

“consistency of implementation of the duty”

is not compatible with our fundamental proposition that combined authorities and combined county authorities are best placed to judge how to put the duty into effect locally.

Furthermore, the requirement on the Secretary of State to define a minimum standard against which to assess authorities would unhelpfully impose a degree of uniformity and have the unfortunate effect of turning a minimum government standard into a default standard. This would constrain local ambition. More broadly, alongside this new duty, we want to simplify requirements in relation to the planning and delivery of health and care services to create more flexibility for areas to respond to the needs of their local populations.

However, I reassure my noble friend that we will pay close attention to how the new duty embeds in the work of combined authorities and combined county authorities to understand the impact that it is having over time, including the different ways in which authorities respond to it. With these reassurances, I ask that the noble Baroness, Lady Scott, withdraws her amendment and my noble friend Lady Royall does not move hers.