Health Bill (Fourth sitting)

Joe Robertson Excerpts

Committee stage
Tuesday 23rd June 2026 Public Bill Committees

[Peter Prinsley]

I apologise for being a little delayed, Sir Jeremy. I am moving the amendment on behalf of my hon. Friend the Member for Stoke-on-Trent South (Dr Gardner). It would place a clear duty on the Secretary of State to have regard to health improvement and health inequalities when exercising functions.

Between 2011 and 2021, the UK was one of only five high-income countries where healthy life expectancy fell. Over the same decade, we faced a cost of living crisis, the covid-19 pandemic and economic decline across the post-industrial regions. We cannot shy away from the fact that ill health is rising. Economic inactivity due to sickness is at its highest level since 2012, and we witness a widening disparity in health outcomes. People living in the most deprived areas of the UK, on average, live just 52 years of healthy life. There is now a 16-year gap in life expectancy between the richest and poorest parts of the UK. Even within individual constituencies, the life expectancy gap can be as wide as seven years between local postcodes.

The purpose of the amendment is to ensure that decisions taken at the highest level of the health system consistently reflect the reality that health outcomes differ sharply depending on where someone lives, the conditions that they live in and their opportunities to achieve good health. The amendment would require the Secretary of State to have regard to the need to improve the health of persons in England. The intention is that this duty would include the need to reduce inequalities in health. That is in addition to the duties that are already in the clause, relating to inequalities in access to and outcomes of healthcare.

At present, the Bill brings together old duties on the Secretary of State and NHS England to reduce inequality in access to and outcomes from NHS services. Those are too narrow and do not reflect the wider determinants of health that the Government have pledged to tackle through their 10-year plan. The amendment would strengthen the duty to reflect the wider cross-Government goals for health improvement and health inequalities. That would make an important statement of the Government’s commitment to improving health and tackling health inequalities, and would set in train an important step towards achieving them.

The amendment also provides a clear definition of “health inequalities” and “general health determinants”. Health inequalities means inequalities in respect of life expectancy or general state of health, which are wholly or partly a result of differences in respect of general health determinants, including housing standards, environmental factors, public transport, economic factors and other wider determinants of life expectancy. The amendment has been drafted to mirror the wording of the newly enacted section 45 duty on combined authorities in relation to health improvement and health inequalities under the English Devolution and Community Empowerment Act 2026.

Accepting the amendment would ensure consistent focus on the mission of creating a fairer country where everyone lives for longer, from the top of Government to regions and neighbourhoods. By setting this out explicitly, the amendment would ensure that future Secretaries of State cannot overlook the wider conditions that shape health outcomes. In sum, the amendment would require that when decisions are made, the Secretary of State must consider their impact on health improvement and on distribution of health across the population.

The amendment is supported by the Health Equals coalition, including 27 organisations that wrote an open letter to the Minister on 15 June. Those organisations range from the Health Foundation to the King’s Fund, Ramblers UK and the Wildlife Trusts, showing the breadth of support from across the sector. The cross-party Health and Social Care Committee also recommended that the clause be amended in this way.

Embedding this duty in legislation would strengthen accountability and ensure that the reduction of health inequalities is treated not as a secondary consideration, but as an integral part of how the health system is led and managed. If accepted, the new duty would ensure clear alignment at national and local levels about the importance of prevention.

[Joe Robertson (Isle of Wight East) (Con)]

It is a pleasure to serve under your chairmanship once again, Sir Jeremy. I will speak generally about the amendments on health inequalities, and specifically about some points that the group of amendments homes in on.

On the general principle of dealing with health inequalities, the sentiment behind amendment 13 is important, and I support hon. Members’ motivation for tabling it, but I question exactly what “persons of different descriptions” means. Does it relate to protected characteristics, which employment law deals with, or to geography? I suspect that it is both, and I wonder whether there are more considerations than those two. It would assist us if the amendment were clearer on that, notwithstanding the fact that clarification may be made during the debate or to the amendment itself if it is accepted later. I have concerns about what “persons of different descriptions” means. Certainly, in everyday English, every individual could be described as a person of a different description, so the phrase does not have any particular legal meaning.

If the phrase means something equivalent to protected characteristics, I wish to say something about health inequalities affecting those of different ages. I am the Member for Isle of Wight East, which, of course, has an older population. I want people of all ages to have equal access to health and social care, and inequalities in access to be levelled out and removed, but it is not only older people who find accessing health services difficult, not least for reasons of physical access; the entire population within an area with an older age demographic is affected. The Isle of Wight has a small local authority. We are fairly unique, in that we are surrounded by water and have a higher age profile, which, taken together with other challenges, makes health equality a challenge for the entire population, not just older people. The issue is aggravated by other considerations, primarily relating to geography.

Amendment 34, tabled by the hon. Member for Winchester, refers to hospital transportation access. That can mean a lot of different things in different places. I support at least the aim of putting more pressure on the Secretary of State and the Department and encouraging them to recognise and eradicate inequalities in hospital transportation access. For my constituents, accessing specialist services means crossing a body of water, which is not only a physical barrier—a ferry has to be taken—but a cost barrier, because ferries cost money. I understand where the hon. Gentleman is coming from, given the challenge in my constituency, but of course other places have different but challenging hospital transportation issues.

Amendment 30, tabled by the hon. Member for Oxford West and Abingdon (Layla Moran), the Chair of the Health and Social Care Committee, refers to cross-departmental working to ensure that health inequalities are taken into consideration. I think this is key. Of course the primary responsibility for health inequalities rests with the Department of Health and Social Care, but it is by no means the only Department with that responsibility. The more we think about the various inequalities that exist in this country, the more we realise that other Departments have considerable responsibility. We hear from politicians—of all parties, but particularly the Labour party in government—about better joined-up working between Departments, but without something more concrete in Bills such as this one, that will remain one of those aspirations that many talk about but few actually achieve.

The most obvious Department to help achieve the reduction in health inequalities is the Ministry of Housing, Communities and Local Government, given its responsibility for local government funding. Of course, local government has primary responsibility for delivering social care and public health within its area. It is a well-known feature of the system we have in this country that healthcare is free at the point of use and delivered effectively by central Government, while social care is a combination of different provision but private funding and local government have the largest role to play, and too many people fall through the gaps in those fundamentally different ways of funding two parts of the system. Unless MHCLG is bound into the way we reduce health inequalities, even with the best intentions of the Secretary of State for Health and Social Care, it clearly will not be delivered in a comprehensive and holistic way.

I refer again, as an example, to my area, which has a higher age demographic but a small unitary authority with a lower funding base. It is a matter of public record that the funding decisions made by the current Government at the beginning of this year have meant an effective reduction in funding for my local authority, notwithstanding its responsibility for an older population and the existing challenges in delivering social care. That is an argument that I and my constituency neighbour, the hon. Member for Isle of Wight West (Richard Quigley), are making to the Government in an ongoing conversation about how we can resolve that issue. We are having that conversation with MHCLG, notwithstanding the fact that it has a very direct impact—the biggest impact, in my view—on health inequalities in my constituency and the effectiveness of the Government’s 10-year health plan and their intention to improve the general health of the population. That is the probably the key departmental relationship that will be relied on to deliver the reduction in health inequalities.

The Department for Transport also has responsibility for this. If we refer to its responsibilities for reducing health inequalities outside the context of this argument, people might scratch their heads and wonder what we are talking about. but as soon as it is brought into a real-life example within this debate, it makes sense that the Department for Transport has some responsibility for reducing health inequalities. However, we will not achieve all we want to unless that responsibility is made more obvious and specific, named somewhere in some Bill. We have an option to achieve our intention to have joined-up decision making, and to ensure that every decision in any Department that has the potential to impact health inequalities is considered, whether in a formal impact assessment or just in the ordinary day-to-day decision making and mindset of the relevant Ministers, Secretary of State or departmental officials.

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[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

It is a pleasure to speak to clause 4 and this group of amendments. Health inequalities are commonly defined as the systemic differences in health status and distribution of health resources between different population groups. There are limits to how far the state can equalise health in a free society, but I am sure all Members would agree that the service should not preside over differences in access to health resources. Unequal access runs contrary to the vision of the NHS as a comprehensive service, available to all and based on clinical need, not ability to pay. Those principles are violated when people without fixed addresses struggle to access general practice, or patients in rural areas, such as my constituency, miss out on treatments—for example, specialist cancer treatments—that are available in more urban areas.

The Health and Social Care Act 2012 inserted section 1C in the National Health Service Act 2006, placing a duty on the Secretary of State to consider the need to reduce inequalities in the benefits that people obtain from the health service. As the explanatory notes to the 2012 Act made clear, the intention of that was to

“include consideration of the need to reduce inequalities in access...and the outcomes”.

Clause 4 of this Bill takes that which was understood and makes it more explicit.

The Minister will be pleased to hear that I support updating that duty—she is smiling. The word “benefits” in the original section is a nebulous and subjective term. The wording introduced by the clause is less imprecise and requires the Secretary of State to consider the whole health pipeline. None the less, I have some questions about the lens that clause 4 and its predecessor, section 1C of the 2006 Act, invite the Secretary of State to look through, particularly in relation to other statements made by the Government.

In the Government’s policy paper “ICBs as strategic commissioners”, they say that increasing the commissioning responsibilities of integrated care boards will result in them being

“better placed to support innovation”

and

“design new models of care”.

Innovation can produce disparities; that is true in healthcare as well. If one ICB decides to innovate and produces a better service, that area will have a better service than another, and the Secretary of State will have the job of undoing that. That could be done by spreading the innovation across the whole of the country, but if the innovation is expensive or difficult to roll out, it could in effect be quashed. Does the Minister recognise that empowering health leaders to innovate and do things differently could widen inequalities, at least in the short term? Is she willing to accept that?

A problem with using inequalities as a stand-alone metric is that it does not really tell you whether things are getting better or worse; it must be taken into consideration alongside a wide range of other metrics. An often forgotten fact is that disparities can be reduced by levelling down as well as by levelling up. Fixating on determining the size and cause of disparities can, in some cases, come at the expense of eliminating them. I recently tabled a written question to ask the Government if and when they plan to

“set an explicit target to close the Black and Asian maternal mortality gap.”

I note that the Minister stood on a manifesto pledge to close that gap. The Government response to my question indicated that they are waiting for Baroness Amos to finish looking at the drivers of inequalities before they do anything. It is possible to produce tomes on the nature of disparities; I suggest that energy would be better spent on addressing them.

Amendment 13 would require the Secretary of State to consider health inequalities arising from differences in general health determinants. I understand the sentiment behind the amendment, as statistically, those with lower earning capacity, limited access to green space or unhealthy lifestyles have comparatively worse health outcomes, but would placing a duty to take stock of that on the Secretary of State make the health service any better for such groups, or for the population as a whole?

What would be the practical purpose of the amendment? As somebody said to me yesterday evening, do we have a section in education legislation stating that the Education Secretary has to consider that their job is to ensure that people are educated? Do we have clauses in defence Bills saying that the Defence Secretary must consider the defence of the realm? I cannot be sure, but the amendment seems to be a statement of the blindingly obvious, so what effect would it have? Does the Member who tabled the amendment think that the Secretary of State will not consider those factors—essentially, that he will not do his job properly? Do they not have confidence in him or in future Secretaries of State?

Under the amendment, the Secretary of State would need to consider inequalities arising from people’s employment, environmental conditions and lifestyle choices, which his Department has little to no control over. If poverty is the problem, the solution is employment and welfare policy, which is not in his gift. If poor environment is the problem, the solution is environmental policy. If a well-informed adult chooses, despite knowing the detriment it may cause them, to consume unhealthy food or an excessive volume of alcohol, or not to exercise, what can and should the Minister do about it in a free society?

Amendment 13 would risk distracting from the focus of clause 4, which is, as I see it, to ensure equal access to health resources regardless of a person’s standing in society. What is the practical effect of making it a duty on the Minister to do these things? Will it cause a whole load of bureaucracy? Will the Minister have to produce impact statements for every new hospital? If, for example, one opened on the Isle of Wight—my hon. Friend the Member for Isle of Wight East was talking about that—would we need to consider what effect it would have on smokers, people who do not exercise or people who have a lower earning capacity, and produce an endless list of assessments? It would take a lot of money and effort and not really add anything. The amendment would also risk the Government getting bogged down in litigation, as people who disagreed with the Government’s or the ICB’s decision would spend their time litigating the question whether something that may or may not even be relevant was considered properly.

Members will not be surprised to hear that my thoughts on amendment 29 are similar to those on amendment 13. I do not doubt for a minute that its supporters have the best intentions, but this type of public sector equality duty language does not do anything to improve public services. Too many arms of the state have been so concerned with disparities that they have become incompetent at getting on with the job that they are actually meant to be doing; they are distracted by trying to measure all these different equalities.

Amendment 30 would require the Secretary of State to involve all Departments in reducing health inequalities and take all reasonable steps to ensure that all other Departments

“consider the impact of their policy proposals on health inequalities.”

Is this spreading the bureaucracy and the impact assessments more widely? If the Government decide to buy a new submarine, do they have to consider what effect it would have on people who smoke on the Isle of Wight? It does not make sense to me. It is a statement of the obvious that members of the Cabinet and Government have to work together to deliver better health for the country. Of course that is true, but what would be the practical effect? The Minister may be able to tell us.

New clause 19 would require the Secretary of State to publish a health improvement and health inequalities strategy within six months, and an annual report thereafter. Again, that would invite more glossy brochures from the Government, using the precious time of civil servants. The new clause seeks a cross-Government approach by mandating that all Ministers of the Crown must have regard to the strategy when carrying out their functions. Again, it is basically stating what their job is.

[Joe Robertson]

My hon. Friend hits the nail on the head. Although all these amendments come from a very good place, they are so obvious that they should already be happening, and are too obvious to be enshrined in some overriding duty in a Bill.

[Dr Johnson]

I agree. The amendments include, in many cases, a statement of what someone’s job is. Does the Member who tabled them think that the Secretary of State is not doing his job and therefore needs to be told what his job is? That could create a whole load of bureaucracy detracting from the actual job in hand.

Amendment 34 concerns transport access. I understand that that is a problem for many people in rural areas, such as my constituency. They often have a harder time, as the distance they need to travel is longer and public transport services are infrequent. Healthwatch, which will be cancelled by this Bill if the Government get their way, has heard from patients who struggle to book transport online, and whose transport turned up several hours early or was cancelled with little or notice at all. Those problems are well documented.

I visited Lincoln county hospital, which has a unit for renal dialysis, where I heard that although transport is provided for individuals having dialysis, which is good, it often does not turn up when it should or does not pick people up at the time that it is supposed to. More concerning is the fact that if they need a transplant and transplant assessments, most have to go to Leicester to have that done, which is several hours’ drive from some parts of Lincolnshire. Most disturbingly, I heard concerns that some people would choose not to go through the transplant programme, and a factor in that decision would be the ability to get to the transplant centre to have the significant amount of testing and follow-up that needs to be done. Clearly, that is not equal access, so I urge the Minister to look at that.

Imposing a duty on the Secretary of State to consider reducing inequalities is a good thing, but it does not magic up the resources necessary to fix them. In exercising his functions, it is a problem the Secretary of State is already capable of addressing. I am sure the Secretary of State, like the Minister, is a good person and wants people to be able to access the services. If Members believe the Government are failing in that regard, I would advise that adding another legislative duty is not likely to bring about the change desired. If we are being honest with the public, we must challenge the premise that every disparity is evidence of a policy failure. The duty placed on the Secretary of State should be to ensure that care is of an equally high standard across the board.

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[Liz Twist (Blaydon and Consett) (Lab)]

I will speak in support of clause 6 and against amendment 58. I work with a great many rare disease groups as part of my work as a Member of Parliament. Those people have specific health needs, and innovation is key to developing ways of dealing with their needs and to making their lives better, so innovation is at the heart of what we do.

We have many great institutions. In my region of the north-east, I will mention Newcastle University, which is doing a huge amount of research into a range of rare diseases and is working collaboratively with other institutions, particularly in partnership, to address those health needs. The clause allows the Secretary of State the breadth to encourage that innovation and to help to make it into a viable spin-off. We too often lose the benefits of the innovation that we create, and it is adopted in other countries.

Amendment 58 would put this important clause in danger of being too prescriptive, and sometimes, if we prescribe particular things, we lose the ability to do other things. I support the clause, and I do not support amendment 58.

[Joe Robertson]

The clause, and amendment 58, deal with innovation. Although the NHS is responsible for some great healthcare innovations, not only in this country but around the world, unfortunately, it is often an example of a complete failure to innovate, or even to use fairly basic technology that has been around for a long time—I am thinking of using computers for patient records, as paper records have lasted for far too long. Promoting innovation is clearly a good thing—it is essential—so I support the amendment. I will speak about the details in a moment.

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[Dave Robertson (Lichfield) (Lab)]

I think this is the first time we have had a Robertson on Robertson intervention. It is a pleasure to break that duck.

The hon. Gentleman is making a powerful point about the need to change culture to embed innovation across the NHS. There is an example that we always come back to: fax machines. Fax machines were used in the NHS for far too long. It was mandated in 2018 that the use of all fax machines had to be stopped by the end of March 2020, yet in 2023, the NHS still owned 600. That mandation came up against a cultural barrier and it did not work, because 600 of them survived for three years after that.

In amendment 58, I see more mandation and nothing on culture. The problem with the amendment is that, by trying to mandate innovation too closely, we would miss the cultural point. We could undermine the Secretary of State’s power to say that all parts of the system are fair game for them. Would the hon. Gentleman like to respond to that point?

[Joe Robertson]

I thank my namesake for his intervention. I do not completely understand what he says, because the amendment refers to cultural barriers. He is absolutely right that we have to be careful when we mandate things, but the strength of the amendment is that it has a broad application and does not seek to mandate specific detail. I accept that it has more detail than the Bill, but its strength is that it gives some direction without being overly detailed. I again draw his attention to the fact that it asks the Secretary of State and the Department to identify and remove cultural barriers.

[Gregory Stafford]

I will not keep the Committee too long. We need to look closely at what the clause is trying to achieve, both on innovation, which I support, and on the prizes. My hon. Friend the Member for Isle of Wight East asked a number of pertinent questions about the prizes, and I want to expand on that before I talk about the amendment in the name of my hon. Friend the Member for Sleaford and North Hykeham.

We have no idea what scale of prize we are talking about. Is it thousands of pounds, tens of thousands of pounds or millions of pounds? Will the prizes be given to individuals or to organisations? Will they be given to NHS bodies? I think not, or at least not exclusively, because the clause suggests that they could be for research. Will they be given to the private sector—I know that Labour Members have antibodies against the private sector—or to university research functions? It is very unclear who the prizes will go to.

Even more interestingly, proposed new section 1CC(3)(b) says that prizes may relate to

“work done at any time (including work before the commencement of this section).”

So they could be given for something that happened prior to the Bill coming into force, but we have no idea how far back that could go. Are we talking months, years or decades? There is no clear outline about who will get the prizes, how much they will be, what innovations or technologies they will be for, or the point in time that is being referred to.

Then the clause says that the Secretary of State may set up a committee. I have been in enough Bill Committees to know that civil servants do not write something into Bills unless they have an idea of what they want to do with it. I would be very interested to hear from the Minister what sort of committee it will be, how many people will be on it, how much remuneration they will receive and how they will establish themselves and fulfil the function that the Secretary of State gives them. If we do not know that, the proposal is so open-ended that I would have real concerns about letting it go forward in the manner in which it is currently written.

My hon. Friend the Member for Isle of Wight East suggested—I do not think he was joking—that the word “prize” made this sound like a game show. That is part of what we need to understand. Will the Secretary of State set up a competition in various areas of healthcare, technology, disease or treatment? Will they say, for example, “We want to find the best technology for dealing with cataracts”? Will a call go out for people to submit bids and say, “We have produced this amazing new laser treatment,” in order to win the prize? Or will it be entirely open-ended? Will people come into the Department of Health and Social Care to this new committee and say, “We have created this amazing piece of innovation—give us some money for having done so”? It is so unclear in the Bill. As I say, I am absolutely certain that the Minister knows the answer to those questions because this clause and subsection would not be in the Bill if she had no idea what she was hoping to achieve by them.