Health Bill

Baroness Lister of Burtersett Excerpts

Committee stage
Wednesday 28th October 2026 Lords Chamber

[Baroness Nargund (Lab)]

My Lords, it is an honour to follow my noble friend Lady Royall. I support Amendment 18 from the noble Baroness, Lady Tyler, to publish a cross-governmental strategy to reduce health inequalities in England. This debate has been extremely humanitarian because addressing health inequalities is a matter of social justice and human dignity.

Health is not created in hospitals or GP clinics; it is created in homes, workplaces and our communities. Health is so fundamental, as Martin Luther King said:

“Of all the forms of inequality, injustice in health is the most shocking and the most inhuman”.


That is what we are talking about—addressing something of a humanitarian nature by addressing health inequalities around our country.

The noble Baroness said about the NHS being criticised. It has often been criticised as not being a national health service but a national sickness service. If we really want to transform our NHS to become a national health service, we have to address health inequalities. These do not lie within hospitals or clinics but in our society and the social determinants of health.

I declare an interest as a founder and trustee of the charity the Health Equality Foundation which works in this area. I also have had the honour of working with Sir Michael Marmot in helping to address the social determinants of health. One of the greatest challenges we face is this nearly 20-year gap in healthy life expectancy, and this cannot be addressed by one department alone nor simply by hospitals. Like the child poverty strategy, we need a whole-government approach to tackling the wider determinants of health—where we are born, how we live and the conditions in which we grow up—which account for 80% of health outcomes.

After having served in the NHS for nearly 40 years, with over 30 years as an NHS consultant, I have treated the consequences of inequality, but I was not able to address the causes of inequality. We have a huge opportunity to address that. I welcome the Government’s manifesto commitment that my noble friend Lady Royall mentioned and the 10-year plan commitment to address health inequalities and the wider determinants of health around our country. The commitment to address health inequalities—not that I know previous Health Bills well—has never been stronger.

The economic case is as compelling as the moral one. If the north of England achieved the same health outcomes as the rest of the country, it could add £18.4 billion to our economy each year. Poor health reduces productivity, increases welfare spending and constrains growth. We know if we want good growth in every postcode, we need good health in every postcode, not just good healthcare in every postcode, which we all know is also essential.

I support this amendment from the noble Baroness, Lady Tyler, because of the need for a cross-government strategy. I have previously spoken in this Chamber about the need for a cross-government taskforce or board; I have also written about that. I believe a cross-government strategy and a taskforce are needed to address our health inequalities and that that taskforce would go beyond this to tackle wider and general determinants of health.

If we want to seriously address this, we must have a cross-government strategy. I recognise the important work already undertaken by the Government in this Bill and the 10-year health plan, but given that many of the underlying causes of poor health sit outside our health service, has the Minister given any consideration to developing a cross-government strategy and potentially a taskforce similar to the one created in respect of the child poverty strategy to address the wider determinants of health? Are there any lessons from that approach that could be applied to tackling wider health inequalities? I am really honoured to have spoken in this debate.

[Baroness Lister of Burtersett (Lab)]

My Lords, I am honoured to follow my noble friend Lady Nargund. I have added my name to a number of the amendments in this group calling for a clear duty on the Secretary of State to take action to reduce health inequalities and produce a cross-government health inequalities strategy. I also support the other amendments on this theme, including that in in the name of the noble Baroness, Lady Bennett of Manor Castle. As we have heard, her amendment makes specific reference to inclusive health groups, including Gypsy, Roma, and Traveller communities, who experience some of the poorest health outcomes of any group in England, as the noble Baroness, Lady Jones of Moulsecoomb, spelled out.

As Just Fair points out, there is a right to health under the International Covenant on Economic, Social and Cultural Rights. In its 2025 concluding observations, the UN Committee on Economic, Social and Cultural Rights raised a number of concerns about the provision of health services in the UK, including inequalities in access to care, as we have heard about.

At Second Reading, I and a number of other noble Lords spoke in favour of a clear duty on the Secretary of State to tackle health inequalities and a cross-government health inequalities strategy that would underpin the preventive approach that the Government, rightly, initially favoured and, indeed, that the Chancellor referred to in his Budget speech today. Our interventions reflected calls from a wide range of health and other bodies, many of which support the Health Equals campaign to put tackling health inequalities on a statutory footing and to reboot the Government’s emphasis on a preventive approach. It also reflected the position of the Health and Social Care Committee in its scrutiny report on the Bill.

The Government themselves have emphasised the importance of addressing health inequalities in their child poverty strategy, as I pointed out at Second Reading. Indeed, the strategy declares that addressing healthcare inequality is at the heart of their health mission. Moreover, in September, the Minister for Women and Equalities, in announcing the establishment of a new class unit, described it as

“a pivotal step in embedding a focus on socio-economic inequality into the heart of government”,

as part of their drive to tackle entrenched inequality. Given all that Ministers have said about inequalities, I am puzzled as to why they seem so reluctant to translate this commitment to tackle entrenched inequality into a statutory duty in this key legislation.

In the Commons, Minister Smyth failed to give a convincing explanation as to how mere empowerment is more effective than a duty to address health inequalities, which she herself said remained a government priority. However, it might not be a priority for a future Government, so warm words are not enough. In the Second Reading debate in your Lordships’ House, my noble friend the Minister reiterated the Government’s commitment to working for greater equality but did not engage with the arguments put by a number of us and explain why a power is better than a duty to achieve this. I therefore hope that she has been able to reflect on what was said and on the growing pile of evidence on health inequalities, especially among children, some of which we have heard about today, and that she will be able to respond more positively and commit to bringing forward a government amendment on Report that meets the objectives of the various amendments debated today.

[Lord Lansley (Con)]

My Lords, I may be the first speaker not to have signed any of these amendments, but that does not mean that I do not agree with them; a great deal has been said with which I agree. The importance of this debate can hardly be overstated.

I just want to contribute one thought, which is that in taking all these issues and understanding how they relate to this Bill, we have to put it in the context of what is already in the National Health Service Act. I want very quickly to outline that.

The Bill before us is an improvement on what is in the NHS Act as far as the Secretary of State’s duties are concerned, because it extends the duty from equal access to healthcare services and facilities to seeking to reduce inequalities and securing equity in outcomes from healthcare services. That is what is in the Bill; I think that is a significant improvement. The Bill focuses at this point on what the National Health Service is doing to secure the prevention of illness and the promotion of successful treatment. It is not about the improvement of public health at that point.

The noble Baroness, Lady Tyler of Enfield, talked about the Bill transferring a duty to the Secretary of State. In fact, the NHS Act has the same duty on both the Secretary of State and NHS England: they are concurrent duties. Therefore, we are not transferring the duty; this is not part of a transfer from NHS England to the Secretary of State.

Under Section 2A of the NHS Act, the Secretary of State has a duty for the protection of public health, which are all those things to do with vaccination, immunisation, et cetera. Section 2B, which was inserted by the 2012 legislation, as my noble friend on the Front Bench will recall, inserted into the Act a duty as to the improvement of public health, and that is on both local authorities and the Secretary of State. It is not, I think, phrased as we would want it to be; more needs to be done to look at that.

I suggest—and this picks up the point made by the noble Baroness, Lady Royall of Blaisdon—that when we talk about wider determinants of health, we are looking at a strategy that relates not only to the Secretary of State—i.e. to the Government—but to local authorities, and she made that point very rightly. But it is in the NHS Act. Local authorities have a duty to improve public health in their area and take such appropriate steps as they can to achieve that, and the Secretary of State has such a duty to improve public health in Section 2B—unaffected, as I understand it, by this Bill. Therefore, when we come to look at it on Report, I hope that those who are thinking about how we might create the right strategy for the improvement of public health do not just think that it is done by attaching it to the responsibilities of the Secretary of State in relation to the NHS but also look at Section 2B.