Health

Baroness Jay of Paddington Excerpts

Thursday 26th November 2015 Lords Chamber

[Baroness Jay of Paddington (Lab)]

My Lords, I thank the noble Lord, Lord Crisp, for introducing this debate in such an informative and authoritative way. It is obviously a very important issue. I wholeheartedly agree with the terms of the noble Lord’s Motion and support his points about the way in which the determinants of health in today’s society are often driven by matters such as alcoholism, obesity and other concerns, which are obviously not the sole responsibility of the NHS, however much we support it.

I think that the way that the noble Lord has proposed is the only way to improve the stark health inequalities in this country. As he reminded us, we are all familiar with the really disgraceful record of discrepancies in morbidity and mortality between different social and economic groups in this country. It has become almost a truism of health economics that low income and low social status are major contributors to ill health, and probably the determining factor in more rapid ageing.

The proposal of the noble Lord, Lord Crisp, for working towards a “health-creating society”—I am still finding it a little difficult to put those three words together—must be the right approach, but my concern this afternoon is: if the ideas and the vision he describes gain general support, how are they to be delivered? How will we make it happen? As noble Lords are aware, there is enormous emphasis nowadays on localism and finding solutions and organising action as near as possible to the communities involved. I worry that there are difficulties in relying primarily on the local approach to tackle some of the somewhat intractable problems of public health.

Of course, community-based alliances of public service, private enterprise and the voluntary sector can often unleash especially effective energy, and there have been some interesting and radical ideas put forward recently on this ground. I was intrigued, for example, by an article by the chief executive of the Royal Society for Public Health, who wrote about the local high street as “an untapped resource” for promoting health. She picked up on the WHO statement that modern society is actively marketing very unhealthy lifestyles, which the noble Lord, Lord Crisp, has already referred to, and argued that stricter local planning laws and differential business rates could drive businesses such as fast-food outlets, betting shops and payday loan shops out of the high street and reduce the tempting opportunities for unhealthy lifestyle choices. I can see the attraction of this proposal, but in the broader picture I fear that the huge reductions in the budgets of local authorities, combined with a lack of local expertise in specialist problems such as sexual health, may make local projects inadequate and sometimes even increase inequalities.

I hope I will not be labelled a centralist dinosaur for saying that national government and a senior Minister must take the lead responsibility for promoting change in this area and achieving the necessary collaboration to build a health-creating society. I was proud to be a Health Minister when the very first Minister for Public Health, my noble friend Lady Jowell, was appointed to that post. She was a senior Minister of State with a wide remit and, although the post has continued in successive Governments, it has not always had the authority of the original appointment and, very importantly from my point of view, it has always been based in the Department of Health. In my view, a Cabinet post should be created—we will have to think of a good title—to take forward the cross-cutting policies we are discussing. This Minister should be based in the Cabinet Office, with co-ordinating powers across government.

My enthusiasm for this approach is partly based on my experience as Minister for Women, when I was based in the Cabinet Office and worked with several departments across Whitehall and with outside agencies. It was a largely successful arrangement. My Cabinet Office team acted as a kind of internal pressure group within the Government; we legitimately raised issues of women’s employment, education, health and pensions across Whitehall and had the authority to do so. I think that the interesting and imaginative proposals for a health-creating society can only be delivered by an imaginative approach from the machinery of government, and I would like to see a Cabinet Minister leading the initiative towards this vision.