English Devolution and Community Empowerment Bill

Lord Hunt of Kings Heath Excerpts

Committee stage
Wednesday 4th February 2026 Grand Committee

Very briefly, on the amendment tabled by the noble Baroness, Lady Royall, particularly its community wealth building element, we have seen multinational companies just suck so much resource and money out of so many of our communities and regions. Allowing communities to ensure that money goes around those communities, rather than being sucked away to London or all too often the nearest tax haven, is something that the Bill just does not do at the moment but needs to do.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I was going to speak in support of the amendment of my noble friend Lady Royall, which is great, but I will respond to the noble Baroness, Lady Freeman of Steventon, wearing my ex-energy hat.

There are sometimes tensions between growth and environmental protections. I pray in aid the saga of Hinkley Point C and the waste of years and millions of pounds spent in relation to acoustic fish deterrence. There are many examples of very bad practice by some of the environmental authorities in the way they deal with these issues. The history of major infrastructure projects in this country is so appalling in relation to the length of time taken that we need to look at this very carefully.

The noble Baroness is probably aware of the Fingleton review into the regulation of nuclear power stations, which was commissioned by the Chancellor and the Prime Minister and came out in the autumn. Broadly, they have accepted it, but at the end of this month they have to respond in detail. What Fingleton recommended is controversial. He basically said that there needs to be one overriding regulator. This is subject to pushback from environmental lobbies at the moment, but people interested in growth are saying that we really have to go with Fingleton. All it illustrates is that sometimes there are tensions and I am not sure that we have yet found a way through them. Clearly, we all want to protect the environment and our habitats, but we also need to have growth. It will be interesting to see how the Minister responds to this.

[Baroness Freeman of Steventon (CB)]

This is supposed to be a guide to best practice. The noble Lord has noted some of the poor practices. A guide would help to avoid some of those. That is important. I totally agree that there has been some terrible practice and it is usually done through ignorance.

[Lord Hunt of Kings Heath (Lab)]

We also have a terrible risk-averse culture among regulators in this country, which we need to tackle as well—but I really rose to support the amendment of the noble Baroness, Lady Royall. I have a later Clause 53 stand part notice, which partly covers the same ground.

Nye Bevan is a great hero of mine. He founded the NHS, but he made one mistake. He beat Morrison in Cabinet in 1947 in terms of the role of local government. Morrison of course had been leader of the London County Council, which, pre-war, had certainly been the largest hospital authority in the world. He argued that local government should be at the centre of the National Health Service. That was rejected, which was a great pity.

I have always believed that local government should play a much larger role, not just in health service provision, but also in health as a whole. My noble friend illustrated why that is important. She mentioned the Health Foundation’s report, which is stark in making clear that health outcomes in the UK are falling far behind those in other countries now. The country that we are most aligned with now is the US, whose health outcomes are pretty disastrous.

We know that we need a co-ordinated, system-wide approach, but what we have is fragmentation. The health service is outwith a lot of the discussions that noble Lords have been having in this Committee. It is very centrally driven. I had some happy years driving it from the centre, but I have concluded that it just does not work like that. We have seriously got to devolve. Local government deals with so many issues that relate to poor health, including transport, low incomes and poor-quality housing—all the things that noble Lords have been discussing. What I am doing, basically, is encouraging my noble friend the Minister to say that her department recognises that it has a bigger role to play in health than it may think.

Clause 44 is welcome. What we are trying to do is urge the Minister’s department to be as ambitious as possible and to do everything that it can to ensure that local government as a whole takes advantage of this. Mr Osborne’s agreement with the leader of Manchester City Council and its chief executive—in 2014 or 2015, I think—led to Devo Manc, which embraced health; it was the responsibility of the combined authorities rather than the mayor. There is enough evidence there to suggest that this is a good thing and that we need to build on it. My disappointment is that nothing has happened since then. The moment Mr Osborne left, no one in government was interested any more. I hope that we can resurrect it and say to local government, “We’re not going to improve our health without you being really important partners in this”.

[Lord Mawson (CB)]

My Lords, I, too, support the amendment in the name of the noble Baroness, Lady Royall, as well as what the noble Lord, Lord Hunt of Kings Heath, has just shared with us.

Earlier, I mentioned “learning by doing” cultures. What do they actually look like? We have been engaging in depth in east London for 42 years. We have pioneered a lot of the things that we now take for granted across the country in parts of the health service, including social prescribing. We have the long view. We spent time looking up the telescope, not down the telescope from government. When you engage in a local community in depth, you soon start to discover that health and wealth are absolutely connected—they are fundamental —yet the siloed systems of the state absolutely miss what all of this might mean and the opportunities that are there in practice.

The Bromley by Bow Centre, which I founded and of which I am now president, has pioneered wide-ranging approaches to these precise issues over the years. Today, we are responsible for 55,000 patients and we have built 97 businesses with local people. If they were here, our integrated health team would tell you that, on a vulnerable housing estate in the East End of London, getting a job has more of an impact on your health than anything that doctors can do in our health centre. All of them would tell noble Lords this. Yet, despite hosting 70 Government Ministers from different parties coming to see us over the past 30-odd years, when we share all this, they all say, “Yes, yes”, then go away. Nothing changes. In Bromley-by-Bow, we are still grappling with 62 different funding sources coming from the Treasury, all of which go down into different silos. We then spend a lot of money, with our staff, on putting things together around the same families. It is ludicrous. I share this with noble Lords: lessons are not being learned. In my view, the fundamental question that is being asked in this amendment is absolutely critical.

This Government are starting to talk about prevention and getting upstream. I agree with all of that but, if you talk to our GPs and our team—we have 2,000 visitors a year, from all over the country, looking at our work—they will tell you that the jury is out on whether this Government are serious about joining the dots around these issues. We will go not on what they say but on what they do. As far as we can see, at the moment there is little evidence that these dots are being joined up, but, if the Government get interested in practice, there is a great opportunity for this Administration and future Administrations coming down the line. This is not a party-political matter; it is a matter for us all and for the health of the nation.

In the 1990s, we realised, through practice actually, that the only way to gain scale with these kinds of issues is to start to partner with the private sector. We took these relationships seriously and today, both in east London and in a programme I lead nationally, we work with the private sector around place-making, and I declare my interests. The private sector is also concerned and interested in these questions. People in the private sector have children and families. Get to know them, dig under the carpet and create learning-by-doing cultures with them, and you will find opportunities to take these kinds of questions to scale. I support the amendment from the noble Baroness, Lady Royall, but I hope that we will move beyond amendments and yet more talk into practice and detail and get curious about what this actually looks like for local people.

--- Later in debate ---

Local growth plans focus on regional economic development, which can of course also relate to, and really impact, local health issues, as noble Lords have pointed out. However, while we agree that local growth plans should be comprehensive and co-ordinated with other strategies, I really fear that this amendment at this time might make local growth plans too broad in their scope unless some cross-government work is done on this matter. I wish it were not so because, if this could be sorted, I am absolutely convinced—and have been for 20 years—that the local community’s health could be much better than it is now, particularly in those early parts of a healthy lifestyle and of stopping things such as obesity and drug or alcohol abuse. This is the opportunity for all those things that happen in communities. I will give to the Minister that job of going and talking to her opposite numbers in the health services. I am sorry for the rant on that, but I feel very strongly.

[Lord Hunt of Kings Heath (Lab)]

It is interesting that at the moment the Government are trying to get the NHS to have an additional allocation to community health services in the planning guidelines. But all indications are that it is not happening, because the integrated care boards are saying that they have to protect acute services first. So community health services are not getting real additional funding. Before 1974, community health was of course run by local government and, with the suggestion to take it out again, I am beginning to wonder whether we do not need to be much more imaginative—basically to ring-fence resources.

[Lord Mawson (CB)]

My Lords, I absolutely feel the pain of the noble Baroness, because we also feel the pain from the other end of the telescope. It is really difficult, and a lot of these systems are profoundly broken. However, this is an opportunity for this Government. The reason why practitioners like me are suggesting that the Government need to create learning-by-doing innovation platforms at place, in real communities, is because that is where the social sector, GPs, the local authority and the NHS can come together to do this stuff and then really learn the practical lessons. That is the only way; it is not through academic papers at 60,000 feet or policy people who have never built anything. It is about practice. Through practice, you will learn where the real blockages are, and what you then need to do is share the lessons learned. Until we get to that place and learn from the micro, I fear that we will keep talking and very little will change.

--- Later in debate ---

[Baroness Boycott (CB)]

My Lords, I am very pleased to follow the noble Baroness, Lady Freeman. What I have to add is that my Amendments 160, 161, 163, 164, 165 and 169 would bring a more climate change-related and environmental aspect to the asks of the Government. As the noble Baronesses, Lady Freeman and Lady Bennett, said, we are really pleased that this is here; I very much feel that we can work together to build on it. Here, I note the work of Leeds University and the Yorkshire and Humber Climate Commission.

My first amendment is on energy. A 2023 European scoping review found that energy poverty and fuel poverty are significantly linked to cardiovascular and respiratory diseases, excess winter mortality and poor mental health, with older people and children among the most vulnerable. A 2022 UCL Institute of Health Equity report found the same facts. It impacts population health at a structural level. In addition, I stress the low-carbon part of this amendment. Since the introduction of the ULEZ in London, gas boilers have somehow managed to become the largest source of nitrous oxide pollution. Air quality is listed in the Bill, but it is important to emphasise the interlinked nature: one impacts on the other.

My second amendment is on water pollution. Recent storms have highlighted—in fact, we were talking about this last night—the number of learning hours lost because of the fact that schools are flooded. We are extremely vulnerable to this, and we have very poor flood defences in our schools. I will not bore the Committee at length about the state of our waterways—every Peer in the place has already done this; I expect a Bill in the next Session—but, between 2010 and 2022, there was a 60% rise in hospital admissions for waterborne diseases in England. This is serious, as they are associated with gastrointestinal illnesses and reproductive and developmental issues.

On resilience, excess heat affects deprived communities more than wealthy ones due to the quality of buildings. A simple thing such as having leafy streets provides proper cooling.

I included my third amendment, on participation in democracy, because studies have shown that increased community involvement can have a really positive impact on health. Personally, I am very excited that, from this month, the National Lottery will devote either 20% or 25% of its entire funding to community engagement, such as community gardening and things like that. It makes a great statement about what really matters to people.

On food and diet, I very much support Amendment 168 on advertising. We know how bad food deserts are and how access to healthy food really affects poorer communities. Last week, I raised the issue of PFAS in a debate on the schools Bill. That is a Defra issue, of course, but it is relevant here because one of the prominent forms of exposure comes through our diet, particularly heating food in a plastic container in a microwave; that is, I am afraid, what lower-income families end up doing—so there is a double whammy.

Amendment 169 proposes a duty relating to allotments and nature-rich spaces. Again, this is something I have talked about a lot. I know that it is difficult for councils to create allotments because they are forever spaces, in a sense, but it is not difficult for councils to grant the right to grow in their communities and to issue meanwhile leases, which is what we did with capital growth in London; we created 2,500 spaces that are still going on now. These really make a big difference to communities. As I say, I am very pleased that the National Lottery is going in this direction on funding, because it will work with the Government and make a substantial difference to people’s real, lived experience.

[Lord Hunt of Kings Heath (Lab)]

My Lords, Amendment 165A is in my name. It seeks to

“include wheelchair and community equipment provision in the list of ‘general health determinants’ that authorities need to have regard to as a cause of health inequality”.

My intention is to highlight to noble Lords that the provision of wheelchairs and community equipment for disabled people is, to put it bluntly, a disgrace. I urge the Government to look at the outcomes at the moment for those who depend on wheelchairs and disability equipment and, basically, to ensure that local authorities and the NHS play their part in putting things right.

As the Wheelchair Alliance has said, at the moment, there are no consistent national standards, there is no independent regulation and there are few clear paths for users seeking repairs, reporting faults or making complaints. As a result, many disabled people face long waiting times, delays in hospital discharge, loss of independence, social isolation and, tragically, avoidable deterioration in health and well-being. It is the same dismal picture with community equipment, embracing hoists, hospital beds, pressure-related mattresses, grab rails, bathing aids, harnesses and all of the other essential items that we need.

The All-Party Group for Access to Disability Equipment recently reported on the systemic crisis in this sector. Carers think that things are getting worse, and the system is inconsistent, underinvested, fragmented and lacking leadership. What is tragic is that this is easily sortable. I am convinced that, if we sorted this out, we would provide a better service at less cost, because the current system is just a complete and utter mess.

The reason why the Bill is suitable is because local authorities and integrated care boards share responsibility for community equipment. Wheelchair services and community equipment often reach the same individual; they should operate in tandem, but they are two distinct systems. In welcoming this very good clause, I would like an assurance that combined authorities, in collaboration with the NHS, will take their responsibilities in relation to wheelchair and community equipment services seriously.

The noble Baroness, Lady Scott, made an important point about the difficulties that local authorities sometimes have in working with the health service and in the release of budget. Here we have a situation where both types of authority spend money inefficiently. I am suggesting that we could provide a much better service. Either the quality will be much better or we will have consistent quality, at least; I do not think that it will cost a lot of extra money as well.

[Baroness Royall of Blaisdon (Lab)]

My Lords, my Amendment 166 would provide a clear mechanism for implementation and accountability of the proposed health duty, while maintaining local flexibility. It would require strategic authorities to produce a health inequality strategy and report on progress every five years.

In many ways, this follows the debate we had on earlier amendments. It is intended to provide a minimum standard and accountability for strategic authorities to adhere to, ensuring that they are meeting their new health duty. The requirement to report every five years was deliberately designed to be the same length of time as the proposed local growth plans will cover, to ensure that they better support one another in strengthening local economies and improving health. The amendment would also ensure that new strategic authorities will mirror existing practice in London, ensuring that health and well-being are embedded across all strategic functions.