English Devolution and Community Empowerment Bill

Baroness Scott of Needham Market Excerpts

Committee stage
Monday 9th February 2026 Grand Committee

[Lord Addington (LD)]

I was waiting for the Minister to reply before I summed up.

[The Deputy Chairman of Committees (Baroness Scott of Needham Market) (LD)]

If I can help the noble Lord, at this point I think that we are expecting the two Opposition Front-Benchers to speak and then the Minister.

[Baroness Scott of Bybrook (Con)]

My Lords, I will speak on a number of amendments in this group that relate to health. They illustrate just how far this Bill stretches and the breadth of its potential impact on matters of public interest. Health is now firmly brought to the fore. Clause 44 inserts new provisions into existing legislation to place a duty on all combined authorities and combined county authorities to have regard to the need to improve the health of the people in their areas and to reduce health inequalities when they exercise their functions. The same duty is applied to mayors of mayoral combined authorities and mayoral combined county authorities.

This represents a welcome shift. It means that health and health inequalities are no longer seen as an issue solely for the NHS or public health bodies, but I hope that the Department of Health and Social Care is aware of these proposals. If it is not and is not fully engaged, we will not get too far. Instead they must be taken into account across the full range of decisions made by combined authorities, whether they relate to transport, housing, planning, skills or economic development. That is an important change, because many of the factors that shape health outcomes sit well beyond the health system itself.

I thank the noble Baroness, Lady Bennett, for her Amendment 159, which seeks to broaden the list of health determinants and health outcomes to be considered as part of this new duty. The concerns that she raises are understandable and I am sympathetic to the desire to reflect the full complexity of what really drives health inequality. However, I ask the Minister whether she believes that combined authorities will have both the capacity and the practical power and resources to deliver against such an expanded list. In the Government’s view, is this expansion feasible? While ambition is welcome, we must ensure that any duty placed on local institutions is deliverable and affordable, rather than well intentioned and unrealistic.

In opening this group, the noble Lord, Lord Addington, spoke about public access to fitness, sport and recreational facilities. These issues are clearly important and, as always, he made a compelling case for the role that access to physical activity plays in improving health outcomes. Many noble Lords will agree with the principles that he set out. It will be interesting to hear from the Minister whether she believes that placing such matters in the Bill is either necessary or proportionate.

The amendments to Clause 44 tabled by the noble Baroness, Lady Freeman of Steventon, seek to align the list of health determinants more closely with academic research. The points that she raises are thoughtful and well made. I would be grateful if the Government could explain how the existing list of health determinants was arrived at. Who decided what should be included and by what process? Was there any consultation and were academic experts involved? Understanding how this list was developed is important so that we have confidence that it is robust and evidence based. In particular, I found the reference to “educational opportunities and attainment” in Amendment 161A especially interesting. Education is widely recognised as a key driver of long-term health outcomes and I will listen carefully to what the noble Baroness has to say on this matter.

I also note the amendments tabled by the noble Baroness, Lady Boycott, particularly those that relate to climate and pollution. These amendments raise issues that are often cited as having implications for public health. However, they also serve to underline a broader issue that runs through this group. The difficulty is not simply whether individual factors can be linked to health outcomes but how far such a list should extend. If climate-related risks and pollution are included, should the same apply to noise pollution, as raised by the noble Baroness, Lady Freeman? What about resilience to heat waves, which was also raised in this group? Each of these can be argued to have relevance but, taken together, they illustrate the challenge of scope. At some point a judgment must be made on where the boundary of general health determinants is drawn. That judgment is important for maintaining clarity and focus within the Bill and ensuring that the resulting duties are workable.

This returns me to the underlying question raised by the group. Who determined which health determinants should be included and on what criteria? What evidence or metrics were used to reach these conclusions? Without greater clarity on this point, it is difficult to assess whether the approach taken is sufficiently defined and proportionate. In that context, will the Government commit today to publishing an explanation as to how these decisions were reached? In particular, will the Minister set out who was consulted in the development of this list, what evidence was relied on and what criteria were used to determine inclusion or exclusion? Providing that clarity would assist the Committee in understanding the rationale behind the approach taken and assessing whether the duty, as framed, is appropriately defined and justified.

Before I sit down, I go back to my plea in the last group. As I have said before, if any of this is going to work, the Department of Health and Social Care will have to be involved. It will also have to work with local government and, by working with it, be willing to devolve power and moneys locally. I look forward to the Minister’s response.