Health Promotion Bill [HL]

Lord Markham Excerpts

2nd reading
Friday 2nd December 2022 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

Like the noble Lord, Lord Addington, I would like to declare an interest in that I still play rugby. If noble Lords take nothing else from this debate, I hope they will find that they have another willing, if perhaps not that able, rugby player to join the team. I hope that my contribution on the pitch will elicit a bit more than apathy, some sympathy and maybe a bit of empathy from my noble friend Lord Kamall. As a keen sportsman, I thank the noble Lord, Lord Addington, for providing the opportunity to debate this important issue. I hope I can do rather better than his impersonation of what I might say in this debate.

On the rationale for OHID’s creation, I must admit to not knowing the genesis or etymology of the change of name, but I will find out. As we know, it was established in 2021 as part of the Department of Health and Social Care, following the closure of Public Health England. Its core aim is to reduce preventable ill health and health disparities. It works towards this under the professional leadership of the CMO, which we felt was key, and the director-general of OHID within the department.

Many noble Lords, including my noble friend Lord Lansley, asked why it was felt that it would be more effective as part of the department. When reforming the public health system, this was carefully considered. This was before my time, but my understanding is that many stakeholders were engaged in this and the feeling was that having it as an in-house, in-the-tent department was the best way to go. The option of creating an arm’s-length body to sit alongside the UK Health Security Agency was considered, but it was felt that establishing those functions within government outweighed the strengths of an independent ALB. The fear was that the proposal outlined in the Health Promotion Bill would create an office for health promotion with limited advisory functions. This would simply replace or duplicate many activities which are already under way in OHID.

In forming OHID, we were clear about the distinct advantages of convening functions—something I have become very aware of in the short time I have been a Minister—and the ability to access expert advice, analysis and evidence, alongside policy development and implementation. The decision to make OHID a core part of DHSC was taken because influence and proximity to decision-making matters. In addition, advice is offered widely from across the system and there needs to be a mechanism for summarising it for Ministers.

OHID is empowered to work across national government, using evidence to influence policy and ensure greater consideration in cross-government decision-making of the links to and importance of preventing ill health and tackling disparities. We only have to think of policy considering the health impacts of housing, the potential of indoor and outdoor air quality to promote or negatively impact health, and the consequences of ill health, including for high levels of economic inactivity, for current and important examples. OHID is taking action on the major preventable conditions which drive ill health and early death, including cardiovascular disease and some cancers, and the risk factors that cause those conditions, including tobacco, obesity, alcohol and drugs. OHID does this work alongside local government, the NHS, academia and industry.

I would like to highlight some of the achievements that have resulted so far. To answer my noble friend Lord Kamall’s point on the health promotion task force, the real north star for the cross-government action we see now was publication of the levelling-up White Paper and the commitment in it to improve healthy life expectancy by five years by 2035 and narrow the gap by 2030. This provides a clear, ongoing framework and commitment—covering DfE, DCMS, DWP, BEIS, DLUHC and the Department for Transport to name just a few—to work across government and really address the major drivers of ill health.

Last December, we published a cross-government drug strategy, backed by new investment totalling almost £900 million over three years, with more than £500 million for local authorities. They are required to provide 54,500 new drug and alcohol treatment places over the next three years. Going back to last week’s debate on tobacco, my belief is that we are on target for our smoke-free objectives, but again, I will check on this and confirm. Another great example is our effort to tackle health inequalities early on. The investment of over £300 million in family hubs and Start for Life will deliver new and expanded family health networks in 75 local authorities.

We are improving joint local working on population health and reducing health inequalities through integrated care systems. This includes an expectation that local directors of public health will play a vital part in informing the strategy developed by the integrated care partnership and the forward plan of the integrated care boards.

In all of this, as was so wonderfully put, exercise is the “wonder drug”. We really recognise its importance. That came through very strongly in the contributions of many noble Lords. The drivers of physical inactivity are deep-rooted and influenced by the places we live, work and play in. Change will not happen overnight.

During preparation of the national plan for sport and recreation report, which lays the foundations for the Health Promotion Bill, noble Lords provided the Government with plenty to consider. The evidence is clear that physical activity is good for health. Being active offers wide social benefits, brings people together, maintains friendships and through active travel, as was mentioned, can help connect people and places. We remain committed to the former Prime Minister’s commitment on active travel.

As we are all aware, activity levels have declined due to the pandemic—I am probably more aware than most of how hard it is to get 15 out on a rugby field on a Saturday. This is not good for children’s healthy development and is putting adults at greater risk of disease. Furthermore, there is a disparity in physical activity levels, as was identified by many speakers. This affects groups including women, older people, people living with long-term conditions, people from lower-income areas and people from black and Asian ethnic-minority groups. The Government recognise the challenge and the renewed efforts needed to ensure people have the access, opportunities and motivation to be active in their everyday lives. Our commitment to the sport and physical activity agenda will continue.

In quarter 1 of 2023—not quite 2022, I accept—the Government will publish a new sport strategy and a new school sport and activity action plan. We believe there is an opportunity for this refreshed strategy to focus on two areas: strengthening action to address inactivity levels, and making the sector more sustainable for the future. We will continue to proactively engage across government and with the wider sector to effectively inform and shape the strategy. This will allow us to ensure that action is focused on the key issues and the right direction for the future.

As mentioned by the noble Baroness, Lady Bennett, everyone should have access to local, safe and inclusive opportunities to play sport, get active and stay fit to benefit their health.

At the heart of the government policy on physical activity are the UK Chief Medical Officer guidelines, which set out how much and which forms of physical activity are essential across a healthy life course. Through our work on the Everybody Active, Every Day physical activity framework there is consensus that long-term, system-wide action is required; physical activity is everyone’s business.

The Government provide primary schools with £320 million per year for PE premium and school active sport, to support schools to provide high-quality PE and at least 30 minutes of physical activity within the school day. This is at the heart of the school sport activity programme, which enables schools to use a whole-school approach to embedding PE and school sports. I will write to my noble friend Lord Moynihan on the specific points he made on access to those activities.

Our action includes continuing to provide ways for people to access local parks and green spaces through the Department for Transport’s walking and cycling initiatives, and the setting up of Active Travel England to support local councils to help people walk and cycle to work, the shops and to school.

Our world-leading digital and social media campaign Better Health provides digital resources and signposts to opportunities to support people to start to become and stay active. As I have part of the digital agenda, I will look to the use of wearables as another way in which we can increase participation and information. Digital health behaviour change approaches such as Couch to 5K have now had 5 million downloads, and Active 10 provides opportunities for people to build up activity levels.

We recognise that progress has not always been as fast as we would like. Our plans should help to change that. Sport and physical activity are golden threads that run through and align actions of government departments, local government, the NHS, sporting bodies and communities. Understanding the data and evidence on what works and what does not is vital to delivering our ambition to shift the status quo and address inactivity. By doing so, we can create access to more opportunities for everybody, especially people living in underserviced communities, to enjoy leading more active and healthier lives.

I am aware that many questions have been raised in this debate. As a new boy I understand that my response to a Private Member’s Bill is slightly different, but nevertheless I commit as in other debates to follow up in detail and writing on all the points, because I want to make sure that the points raised today have an appropriate response.

It is a privilege to be speaking after such accomplished speakers: some of the sports athletes here today, former Ministers and Secretaries of State for Health, chairs of sporting organisations such as ukactive and others, and top health professionals. They make my Saturday afternoon rugby efforts look rather weak in comparison.

We are all united in wanting to find the best way to promote healthy living through sport, education and active lifestyle. I know we want the same thing, which was probably put best by the noble Lord, Lord Crisp, as health creation, prevention and services. Some strong and passionate views were expressed on that and some excellent points were made.

I think noble Lords are also aware that I have a very broad background, with many leadership roles in businesses, charities and arm’s-length bodies, and I have been involved in four government departments and now government itself. Honestly, I have seen many different organisational models, both centralised and decentralised, setting up ALBs and having departments inside government. I can say from personal experience that in every one of those, in each instance it took a while for a new organisation to bed down and become effective. It took probably at least a year before you could really see its effects, and I believe that is the same in this instance. Therefore, while I understand and support the reasons expressed today, it is important that we need to give OHID time to take root, to see the publication of the sports strategy by DCMS with our involvement in quarter 1, and judge it on the results. However, I undertake, having listened to this debate today, to come back to the House and speak again on this subject when I believe it has had a proper amount of time to see whether it is working or whether we need to think about some other ways of setting it up.

For these reasons, I maintain my belief that the best way to achieve the objectives set out—which, as I said, were described so well as health creation, prevention and health services—is by OHID as a key and central part of government.