Health Bill

Lord Mawson Excerpts

Committee stage
Wednesday 28th October 2026 Lords Chamber

[Baroness Gerada (CB)]

My Lords, one of the people who I have most admired over the years is the American paediatrician, Professor Don Berwick—some of your Lordships may know him—who is an international expert on healthcare and a great advocate of the NHS. In fact, he led the Mid Staffs review in 2013. In the States, he led Medicare and Medicaid under President Obama. It always struck me that Don Berwick wrote us a birthday card on the NHS’s 60th birthday. It was a long card and I urge your Lordships to read it one day. He offered a simple prescription for the NHS: “Stop restructuring”. He warned that successive reorganisations drained the workforce’s “energy and confidence” and argued that stability makes improvement easier. Does the Minister agree that his advice would be well taken?

[Lord Mawson (CB)]

My Lords, I welcome this debate and I certainly support the amendment. I am encouraged by the letter that we received today that there is an open mind within government and a proper discussion taking place about these very important issues. I am a practitioner, as many of your Lordships know, and we are involved in trying to build some of this new health infrastructure around the country. Indeed, today I have been involved in quite an exciting conversation about a health innovation campus in Huddersfield that we are supporting, which has major implications for this Government’s direction of travel—a lot of which I support—around place, collaboration and other things that the Prime Minister has talked about.

However, we are also in touch at the front end with what is actually happening on the ground, and the word I keep hearing from colleagues across the country is “chaotic”, which is a worrying word to be hearing. Therefore, this debate and the detail that is being discussed today really matter for the NHS, for patients and for those of us who are trying to build this infrastructure. Therefore, I am encouraged that the Minister is starting off in an open, transparent and conversational manner in Committee. It is very helpful.

One of my concerns about the changes taking place at the moment is that there does not seem to be a clear vision about prevention. Those of us who have been involved in this space—in my case, I have been involved in east London, and now nationally, for over 40 years—know that on the ground, in very challenging communities, the real determinants of health often have nothing to do with doctors. If you asked our GPs in Bromley-by-Bow, they would tell you that a person getting a job does more for a person’s health than anything to do with doctors. That is why, in Bromley-by-Bow, we ended up building 97 businesses with local people, because we got real about the social determinants of health. It is about whether you have a decent home that is not damp. It is why we built a housing company, which now has 10,000 properties and owns 34% of the land in Poplar. It is to do with whether your relationships in your family are in a good place and whether you feel part of a community—all these things. The numbers that people far cleverer than me come up with say that the impact of all this is 70% to 80%.

I am not clear, with this real opportunity to reform the NHS in this century and with the things we now know, what this Government are saying about the prevention agenda and how clearly they are or are not joining the dots around the social determinants. Part of this conversation is really important, but part of it needs to be about the prevention agenda. As we work our way through Committee, we need far more clarity about what that will mean in practice and in detail in communities across this country.

[Baroness Harding of Winscombe (Con)]

My Lords, it is a privilege to follow the noble Lord, Lord Mawson, and the noble Baroness, Lady Gerada, who between them have many decades more experience than I do of NHS and health and care reorganisation. I have only one major experience from the inside: the last time we were debating the restructuring of the NHS in 2021-22. At the time, as someone from the private sector, I was somewhat surprised to discover that the NHS got on with the reorganisation before the legislation was passed. It is even odder this time: the NHS has started before the legislation but without a plan itself.

Therefore, I welcome this amendment from my noble friend Lord Howe. It is essential that we understand the plan and the timetable, what it will cost and what benefits it will bring. It really is very straightforward. If that does not exist, the idea that it can be complete by 1 April next year is completely gobsmacking. Maybe I am just an innocent businesswoman who does not understand the ways of the NHS, but it just does not seem right. I think this amendment is basic common sense.

Much as I hear the words of wisdom from Don Berwick, I support merging NHS England with the Department of Health. I saw from the inside, particularly during Covid, how important it is to have clear political accountability. I support the basic premise, but I am very worried that the tendency will be to centralise rather than to push resource out to the regions and local communities. As the noble Lord, Lord Mawson, just said, it is at the local ground level that change really happens.

I am very supportive of seeing fewer people employed in organisations that bear the NHS brand but do not actually treat patients. There are tens of thousands of people who are all trying hard and doing valuable work, but they are a long way away from patients. As we bring NHS England into the department, I would love to see, as part of this amendment, a clear breakdown of the cost savings at the national, regional and local level, so that we have sight of whether we are really pushing accountability, and resource and capability, down to where change will bring the benefits that we all seek.

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[Baroness Thornton (Lab)]

My Lords, I do not intend, by and large, always to follow the noble Lord, Lord Lansley, if I make a remark to your Lordships’ House, and I will not go into the reasons for health inequalities, because they have been spoken to very adequately by the noble Lord, Lord Patel, and my noble friends Lady Royall, Lord Hunt and Lady Nargund. However, I want to say something about social care because, although the noble Lord, Lord Lansley, is quite right about public health and the need for prevention, none of this is going to work or be delivered—I make no apologies for saying this and I will keep saying it—including the 10-year plan and integrated care, unless we also address the issue of social care inequalities. As I am chair of the Social Care Institute for Excellence, the Committee would be expecting me to talk about that.

We recently did research, which has been published, about the inequities experienced by people who use social care. I thought it might be useful to remind the House what that said, because it will sound very familiar when we are talking about health inequalities. It was about people with lived experience, because our work in SCIE is based on people with lived experience, and co-production. It said:

“These policy and practice implications are reflected … by participants: a named point of contact to help them navigate the complex system … better continuity of carers to improve the quality of care and reduce the burden of having to explain one’s needs”,


as we hear time and again,

“clearer and more proactive information to ensure everybody is aware of their entitlements … investment in the workforce to encourage greater professionalism and retention … more consistent provision across areas to reduce the postcode lottery”.

We could be talking about the inequalities we have just been debating; the same applies in social care. The reassurance I seek from my noble friend the Minister is that that will be recognised as we go through this legislation.

[Lord Mawson (CB)]

My Lords, I found this an interesting debate, and I am sympathetic to the amendment of the noble Baroness, Lady Bennett, and particularly that of the noble Lord, Lord Patel, because he is right that very little is actually being learned. My colleagues and I have listened, over the years, to lots of conversations about health inequalities. When you spend your life in very challenging housing estates and see very little changing, you know about the distance between all the words and the practice.

That is why, many years ago, we decided to focus on practice and the doing of things, rather than the talking about things. We began to realise what every parent knows: that you only really learn by doing. When I started to work with GPs, originally in east London, they began by telling me that was how you became a GP. You saw one, you did one and then you taught one; it was a very practical matter. Businesses and entrepreneurs nowadays know that you learn by doing things. Yet in the state, which often feels so out of date in the NHS, there is no learning by doing culture. There is a learning by writing very fine reports, often at 60,000 feet, that seem very unengaged with practice.

Over the years, it has been interesting to observe what happened through practice. The Bromley-by-Bow model is well known, so I will not use it, but the noble Earl, Lord Howe, knows that I was also responsible for the transformation of a street following a murder and 10,000 illegal injections being given out in a housing estate. There were some terribly violent circumstances going on at the time. When I brought the first key people on the street together, all of them—the GP, the school and the housing association—were saying, “We cannot deal with this on our own. We need to do it together. These things are so interconnected”, and we built together the St Paul’s Way Transformation Project, which started with nothing and led to a new £40 million school, a £16 million health centre, 600 homes and now a new primary school.

We joined it up, and Professor Brian Cox and I led our 14th science summer school in June this year, with a masterclass at the end of it on quantum physics, for the children from the same housing estates. It is the same children and same families, and now they have one of the best performing schools in Tower Hamlets. The noble Earl, Lord Howe, helped us greatly at one key point with learning by doing, when he met the whole group—housing, health and education—when the NHS was getting in the way of us completing on the deal for the health centre. He was very helpful in enabling that to actually happen.

It was Duncan Selbie, the chief executive of Public Health England in 2015, who gave me £20 million and said, “Andrew, take this culture that you’ve been developing into the north of England”. We built 10 learning by doing innovation platforms in Rotherham, Bradford, Doncaster and Bootle, all of which were about bringing people together to learn about these matters. It was interesting that when I met the public health officials in each of these places, who were lovely people quoting all the same data that I had heard many times before, and said to them, “What are you actually going to do about that data?”, there was absolute silence. It was not their fault. They did not have the skills to know how to turn fine words into practice for some of the most challenging communities in this country.

It is my view that one of the things being missed in this moment is the serious need to get real about innovation and learning by doing. My colleagues and I—I declare my interests—are at the moment creating at place, on the ground, with local people and professionals, what we call these learning by doing innovation platforms, so that we bring together the actual GP, business person and local resident, and you begin to explore these issues together because in the modern world, health is everybody’s business. It is not just a matter for GPs. It is interconnected and we need to explore what that means.

My concern about where we are at the moment in discussing this Bill, which is a fantastic opportunity for this Government, and this country, to move into a form of health that is of this century and not last century, is that we are going to end up building a lot of biomedical boxes around this country that do not explore these interfaces in some of our most challenging communities. The noble Lord, Lord Patel, is right; we need to worry about why he is right and why things are not being learnt.

I finish with the thought that it is our experience over the years that, sadly, we have to say that, in so many respects, the NHS is not a learning organisation. We must have hosted 70 Government Ministers to our work over the years. They all come and say, “Wow, this is fantastic, we need to do more of it”. I can name the four who did anything practical about that, and the other 66 sit on a list in this pocket. This is not to do with bad people. It is about whether, as a nation, we are now going to get upstream into prevention and health creation and create a learning by doing environment in which we all learn together, and in which local people are part of all of that process.

[Baroness Pidgeon (LD)]

My Lords, this is a very important group of amendments, and it has been a really excellent debate. One of the most pressing issues facing us is the widening gap in health outcomes between different communities. Healthy life expectancy has fallen in recent years and the gap between the most and least deprived areas of England, as we have heard, now stands at almost 20 years.

The point made earlier by the noble Lord, Lord Crisp, when he talked about the role of the department being one of leadership for health across government, not just running the NHS, is really important as we approach this group of amendments. We have heard clearly that the current legislative framework places relatively weak duties on government to address these wider determinants of health and tackle inequalities.

The House of Commons Health and Social Care Select Committee, in its scrutiny of the Bill, called for a stronger focus on improving the nation’s health and tackling inequalities, emphasising the need for clearer accountability and a more robust approach to prevention across government. Many of the amendments in this group would help to achieve that aim by ensuring that reducing health inequalities becomes a central objective of health policy, and that progress is measured and reported transparently.

My noble friend Lady Walmsley’s amendments, spoken to by my noble friend Lady Tyler, and Amendment 7 from the noble Lord, Lord Patel, would strengthen the duty on the Secretary of State to take steps or action, rather than simply “have regard to”. That is really important. Amendment 14, tabled by the noble Lord, Lord Patel of Bradford, and supported by so many Members of the House today, would require the Secretary of State

“to have specific regard to reducing inequalities”

in coastal communities. The point has been made clearly about the added complexities for such communities, whether those are workforce related or in local service provision. Those are really important.

My Amendment 20 looks at health inequalities in urban areas and requests a strategy and an annual report. Impact on Urban Health, which is part of Guy’s & St Thomas’ Foundation, recently reported its State of Urban Health research and found that preventable mortality is 2.7 times higher in the most deprived urban neighbourhoods in England than in the least deprived. Urban areas also face some of England’s starkest health inequalities, with people living just streets apart experiencing significant differences in health. You have only to look over the river to the London Borough of Lambeth, where Impact on Urban Health is based: females who live just over a mile apart face an eight-year gap in life expectancy. As we have heard, these inequalities are driven by unfair and avoidable differences in everyday environments. These include exposure to air pollution, differences in housing quality and access to healthy, affordable food. I pulled this area out for specific attention: rather like the coastal communities amendment, it needs specific action.

My noble friend Baroness Tyler spoke strongly to Amendment 18, which would require a cross-government health inequality strategy and subsequent annual reports to Parliament on progress. That would focus minds and energy across government and would address the key point from the Health and Social Care Select Committee, as well as many of our suggestions in amendments and today’s debate.

If we are serious about narrowing the gap in healthy life expectancy and giving everyone the opportunity to live a healthier life, then action on the wider determinants of health and tackling health inequalities must sit at the heart of the Bill, not at its margins. I look forward to hearing the Minister’s response.

Health Bill

Lord Mawson Excerpts

Committee stage
Tuesday 3rd November 2026 Lords Chamber

[Lord Patel of Bradford (Non-Afl)]

My Lords, I support the aims of Amendments 22 and 24 and welcome the intentions of Amendments 67 and 68 in this group.

I want to concentrate on what these proposals would mean in practice for patients and families. The question is whether choice is meaningful, accessible and protected throughout their care. For patients, the questions are straightforward: where can I receive appropriate care, how long will I wait and how will I get there? Amendment 22 rightly draws attention to the information that is needed to make those decisions, including waiting times, location, quality and travel costs. Simply presenting someone with a list of providers does not necessarily give them a meaningful choice. A service offering an earlier appointment may be difficult to reach, while a nearby service may involve a much longer wait. Patients need help to understand those options and decide what works for them.

Does the Minister accept the case for strengthening patient choice in services outside of hospital? Whether she accepts Amendment 22 or not, how will the Government ensure that patients receive the information and practical support that is needed to exercise choice, particularly those patients who cannot readily use digital services, have communication needs or require help with transport?

Amendments 23 and 24 raise an equally important question about onward referrals. A patient’s ability to choose should not depend on which door they entered through, or which organisation happens to make the next referral. As services become more integrated and virtual services play a greater role, we must ensure that patients are told about the choices that are available to them. Integration should make their journey easier, while preserving access to suitable providers beyond the organisation arranging their care. Can the Minister explain how patients will be protected from being directed automatically to a closed list of preferred providers without being offered the choice to which they are entitled?

Amendments 67 and 68 raise a related issue about choice in community services, including eye care and audiology, very eloquently expressed by the noble Baroness and the noble Earl, Lord Howe. Moving care closer to home should bring benefits to patients. We should ensure that a change in the setting or organisation of care does not unnecessarily narrow their options. For a family seeking an ADHD or autism assessment, choice can also have very practical consequences. Where choice rights apply and an eligible provider can offer appropriate care sooner, families need to know that this option exists and understand what the service includes. They should also have the confidence that their choice will be respected as referral pathways change.

As the noble Earl said, choice must operate within appropriate clinical criteria, with providers meeting the required standards and regarding the sustainability of local services. It must also be available fairly, rather than depending on a patient’s confidence or ability to navigate the system. Can the Minister explain how existing choice rights will be protected as services are reorganised, how compliance will be monitored and what remedy a patient will have if available choice is denied? The practical test is whether patients can reach appropriate care sooner, with clear information and continuity of treatment. I hope that the Minister will respond to the concerns behind these amendments and explain what the Government will do to make meaningful patient choice a reality.

[Lord Mawson (CB)]

My Lords, I too support Amendment 22 and am encouraged by this debate, which definitely needs to happen. Indeed, the GPs I work with in the East End of London would definitely want to open up these very choices to patients from many different backgrounds, because sometimes one can get a sense on the ground, certainly in challenging communities, that the NHS can be quite condescending to people in assuming they do not want these kinds of choices. Yet if you go into East End housing estates you will find lots of different people living there from lots of different backgrounds who do want choice. This is a really important message and needs to be grappled with and taken seriously.

Health Bill

Lord Mawson Excerpts

Committee stage
Wednesday 11th November 2026 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

My Lords, I will speak very briefly to these two amendments. It is a great pleasure to follow the noble Baroness, Lady Hollins, who made some of the points that I intended to make. We really need to give people the chance to meaningfully participate and to be part of society. Good work may be one route to that, but it may not be suitable or available to everybody.

The noble Baroness said that there is a great deal of not-good work out there, and I will point to some figures that recently came out on the loss of autonomy across the entire workplace. In 1992, 62% of people said that they had a great deal of discretion over the task they conducted and how they organised their working day. In 2024, that figure was 34%—it very nearly halved. People are not getting a sense of agency and autonomy in their workplace. That is without me getting into, as the noble Baroness did, the issues of zero-hours contracts, inadequate wages, unpaid overtime, et cetera.

Having said that, Amendment 279QF has some very good elements. I particularly applaud proposed new subsection (3)(a), which states that

“the Secretary of State must consult … young people with lived experience of mental health conditions and of being out of education, employment or training, and their families and carers”—

nothing about us without us. It is crucial that it is there, but I respectfully suggest to the noble Lord, Lord Singh, that perhaps this would be better as a “good work and meaningful participation in society” amendment or something along those lines.

I am afraid that I respectfully disagree with Amendment 48 from the noble Baroness, Lady Coffey. I will be interested to hear what the Minister says about it. A basic principle of the NHS from the very start has been that healthcare is provided on the basis of need. Giving the Secretary of State a special duty to help get people back into work would take away from that basic fundamental principle. Not making it on the basis of need and seeking to use the NHS to serve the economy would be a disturbing change in principle that needs to be highlighted and questioned.

In introducing the amendment, the noble Baroness talked about prescribing a job. That terminology would be really frightening to many people. I have met people with serious mental health conditions—we know there are significant numbers of them, including people in the NEET category—who are not applying for benefits, stepping away from the system and not getting help because it is really frightening to them. We absolutely do not want them doing that with the health service. If the health service were seen as a place of fear or compulsion then that would be dangerous to their future health and well-being and, indeed, the future health and well-being of society.

[Lord Mawson (CB)]

My Lords, I welcome these two amendments because they encourage us to debate a very important matter—employment. I have said before that the GPs I work with would remind us that, in the very challenging communities in which they work, getting a job does more for people’s health than anything they can do as doctors. We have done lots of work in this space over the years in east London and we are now replicating that practice around the country. It is why people like me are encouraging the health service and the public sector to learn from science and business that you innovate and learn only by doing things, not by writing clever reports or academic documents at 60,000 feet. You actually have to engage.

For example, to pick up the point from the noble Baroness, Lady Bennett, we have been running for over 15 years, with Investec, a jobs and small business programme in east London. It has been enormously successful. We have built 97 businesses, or local people have, many of them with health, mental health and other complicated conditions. When you get into the granularity of all that and you watch people’s lives, you watch what happens to their children and their family when they get a job and how things actually change, it is an extraordinary thing, that journey. It is a journey, I feel, and that is why I have been challenging the direction of travel of this legislation and this Government, because I fear we are missing a serious opportunity. If it is true what Michael Marmot and some of us saying—we come to very similar numbers that 70% to 80% of the determinants of health are social and nothing to do with doctors—then we enter this space, which is really important.

I declare my interest: I am working on a 30-acre site in Surrey at the moment, with a school that has been in very difficult circumstances. In the middle of that, there is an old primary healthcare building stuck there, disconnected from the school. There is a college behind a fence over there, which is doing what the head teacher would describe as babysitting children. Is this really about employment or is it ticking boxes? You have a large piece of land where you could bring health, education and housing together in a very interesting environment. We are looking at that opportunity. There is a real opportunity there to build what this Government call a neighbourhood health centre.

I am into all that, but neighbourhood health centres in the modern world cannot be just about bringing biomedical people together in a building—a biomedical box. That is not taking seriously what this conversation is about. We need to build multidisciplinary teams. We got into employment, health and wealth seriously over the years. We have even done projects with eight year-olds on developing their business plan. It is really interesting what happens when you do that with children. It would be interesting to have the Minister’s response on this. There is an opportunity, with neighbourhood health centres, to innovate, do something seriously and pick up the strands of this discussion.

I suggest that the way we get beyond the concerns from the noble Baroness, Lady Bennett, is to create practical learning by doing cultures on the ground, because all that theoretical stuff then falls away as irrelevant. You get into people with names and addresses, you watch what happens as you bring business, entrepreneurs, health practitioners and teachers together on the ground, and you start to build multidisciplinary teams. Innovation and something rather different happens. It absolutely relates to what the noble Lord, Lord Singh, said. I have been involved, as has he, in mental health, because mental health is a really big issue in these communities. You begin to get into the detail of that and beyond the theory into practice. When you watch a young person or an adult move away from many years of dependency and drug use—much of that drug use, by the way, at great expense from the NHS—you watch them take on life and see what happens to their children and family, my goodness it is a great inspiration. My view is that that is what these neighbourhood health centres should be about is multidisciplinary teams, learning by doing and getting into the granularity of what this discussion is about.

[Lord Kamall (Con)]

My Lords, I am grateful to my noble friends Lady Coffey and Lord Singh of Solihull for their amendments, and, in fact, to all noble Lords who spoke. We know that ill health is an issue not only for individuals, families and the community. At the macro level, it is a principal driver of economic inactivity, with millions of people of working age not working because of long-term sickness. Recently, my noble friend Lord Howe and I met with a GP who wanted to share his experience. He said that he was told that 93% of all notes that GPs sign are sick notes, so only 7% were to return them to work. His suggestion was that maybe the GPs in those situations should be asking for a second opinion, because there is a clear imbalance going on.

For many, work provides more than an income. It offers independence, purpose, structure and social connection, and losing that connection due to ill health has wider consequences, as the noble Baroness, Lady Hollins, and the noble Lord, Lord Mawson, said. Both my noble friends said that we should think of employment not simply as a matter for the Department for Work and Pensions but as part of someone’s well-being. That was very well illustrated by the real-world example that my noble friend Lord Singh of Solihull gave from his experience as a psychiatrist.

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[Baroness in Waiting/Government Whip (Baroness Hyde of Bemerton) (Lab)]

My Lords, I thank the noble Lord for that warm welcome.

With permission, I will address Amendments 48 and 279QF together, which look at the very important relationship between health and work. I agree with the point made by the noble Lords, Lord Mawson and Lord Singh, and the noble Baronesses, Lady Hollins, Lady Bennett and Lady Coffey—possibly all noble Lords who have contributed today—that good work, and I say that advisedly, is good for health, which is why we are already taking action to address the relationship between work and health. I agree with the noble Lord, Lord Singh, that work and health are not competing interests. I agree with the noble Lord, Lord Kamall, that the responsibility for good health does not sit just within the DHSC.

We already have programmes that bring together health and employment support around the individual, including health and growth accelerators. We are already acting at scale. This month, WorkWell began its national rollout across every ICB in England, building on pilots that have already supported around 25,000 people. Backed by up to £259 million over three years, the expanded service could support up to 250,000 people with health conditions to stay in work—this goes to the point made by the noble Baroness, Lady Coffey—or return to work. The 10-year health plan is clear on the critical role that the health system has, alongside local partners, in addressing health-related economic inactivity, especially through prevention and early intervention, which the noble Lord, Lord Singh raised.

Sir Charlie Mayfield’s independent Keep Britain Working review, published a year ago, highlighted the scale of the problem of people falling out of work for reasons of ill health and disability, including mental health conditions, and the vital role employers can play in addressing this. Further, the Government are already taking forward the development of a better model of workplace health provision through the Keep Britain Working programme. This system is intended to improve access to support for employers of all sizes, including the small and medium-sized enterprises referred to by the noble Baroness, Lady Coffey, and will be supported by a robust, recognised BSI employer standard. We are testing reforms to the fit note process so that the system works much better for patients, employers and GPs. These are aimed at moving from administrative sickness certification to a service focused on getting people the support they need to stay in work or return sustainably.

Finally, we have commissioned the recent Fonagy review and the forthcoming independent Milburn review, given the importance that the Government place on the relationship between work and health. Alongside this, given that several noble Lords mentioned young people, the Government are investing £2.5 billion by 2029 into the youth guarantee and the growth and skills levy. This investment will support young people and create up to 500,000 opportunities to learn and earn.

We do not believe that additional statutory duties or reviews are the right approach here. We are happy to offer the noble Lord, Lord Singh, the noble Baronesses, Lady Coffey and Lady Hollins, and other contributors today a meeting with the officials working on the Keep Britain Working thread. The Government are already taking significant action in the health and work space, and I hope that noble Lords are reassured that the Government recognise the importance of this issue.

[Lord Mawson (CB)]

My Lords, this all sounds fine in theory, but people like me are nosy—we go and have a look under the carpet at what is happening, in detail, in the machinery. Often, this machinery means well but the structures and siloed systems prevent the kinds of relationships that need to happen in the modern world.

I will illustrate this. From 2015, for many years I led the Well North programme for Duncan Selbie, which has now evolved into a national programme. It is interesting to talk to the Well Doncaster programme, which the noble Baroness, Lady Armstrong, will be pleased to hear now has 34 staff and operates across Doncaster —it is a fantastic success story and some great things are happening there. But I was talking to one of our lead colleagues there just a few weeks ago, who was saying that, in Doncaster, the Pride in Place programme is completely disconnected from this programme. I am sharing this with the Minister because there is a desperate need to get under the carpet of these practical issues, otherwise we will say all these wonderful things but—I say this from experience—very little will change.

[Baroness Hyde of Bemerton (Lab)]

I thank the noble Lord for those points. I recall that I did not answer substantively his point on neighbourhood health, and the further point he has raised cuts to the heart of that. I am very optimistic, as a former lead member in a local authority and now a Minister in this place, about the opportunity of neighbourhood health. It is a great moment to get away from the model of a clinical box and viewpoint and work holistically across a wide range of services. Let us continue to look under that bonnet together, because we are driving at the same aim here: improved health for all our communities, outside the silo of DHSE.

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[Baroness Pidgeon (LD)]

My Lords, we have had a really good debate on this group of amendments. My Amendment 216 addresses one of the most persistent inequalities in our healthcare system: the growing number of communities that simply cannot access an NHS dentist. For too many people, finding an NHS dental appointment has become an impossible task, with entire areas effectively becoming dental deserts. Other amendments in this group are very much in the same place.

Amendment 216 would require the Secretary of State to establish a scheme specifically designed to tackle that problem, ensuring that integrated care boards can guarantee emergency access to NHS dentistry and provide free dental check-ups to children, mothers within one year of having given birth, pregnant women and low-income households. The amendment recognises the current state of access to NHS dentistry across the country, and that preventive care is better for patients and more cost-effective for the NHS than treating advanced dental disease later.

However, my amendment would go further by recognising the critical importance of dental health for patients facing serious medical treatment and guaranteeing dental appointments for those about to start chemotherapy or undergo transplant procedures. It would help ensure that necessary treatment was not delayed because of untreated dental problems and would support those patients at a time of great need.

In this debate, we have heard of how dentists are remunerated. My amendment would require the publication of a reformed dental contract before the scheme was introduced, because the current contractual arrangements have contributed significantly to the workforce shortages and access problems that we see today.

My amendment is practical and targeted at ending dental deserts, improving access to dental care and ensuring that NHS dentistry is once again available to the people who depend on it. The noble Lord, Lord Patel, and the noble Baroness, Lady Coffey, have given clear examples of the different needs of coastal and rural communities and the importance of access to transport for access to services, which too often gets forgotten in these debates.

The amendment from the noble Lord, Lord Hunt, to which I have added my name, would ensure the publication of an important, regular report on the state of NHS dentistry and a debate in Parliament, which would keep a focus on this issue. There is so much going on in the health space that this can easily get lost, which in some ways has led to the situation we are in today.

We mentioned children in our debate. More than for any other reason, children attend A&E because of tooth decay. That is extraordinary. We can talk, and we have talked, about how we are tackling the issue—we have programmes teaching children how to brush their teeth properly—but what are we doing in nurseries and other early care settings? Only 10 years or so ago, my son was in nursery. That nursery had an NHS dentist who came in every six months and did check-ups with the children, and you got a note sent home. Why are we not looking at some of that preventive work? This report would allow the wider debate that we have started today, as well as discussion of some of the other important points and links to other health issues. I hope the Minister will respond positively and pick up the issue of that regular report.

[Lord Mawson (CB)]

My Lords, I support the amendment from the noble Lord, Lord Hunt. I will share a practical experience. In Tower Hamlets, a large proportion of the residents are Bengali and eat betel nut, which produces all the symptoms and serious health impacts that the noble Lord, Lord Kakkar, has well described. I have previously mentioned the street we rebuilt following some very difficult health circumstances. We ended up building a health centre, a school, 600 homes, and now a primary school, and we joined it all up with a multidisciplinary team. When you bring the headteacher, the GP, the pharmacist and the housing practitioners together, you start to learn things about the community in which you are based, and we began to discover this serious health implication among the Bengali community.

Because we had a very good working relationship with Queen Mary University, which is up the road and which became a partner in this development, there was an opportunity to bring a dental school, with a brilliant professor of dentistry, on to the street. We could then connect it to the pharmacy, the school and the science programme—which we have been running for 14 years with Professor Brian Cox—and create a whole joined-up situation that would not only improve the dental health of people but, if we connected it properly into the school, might well produce more dentists. It would mean that, instead of the health centre being overwhelmed by these issues, the dentists could start to deal with patients and the detail of all this. My point is that, if we began to think of neighbourhood health centres not as a box but as a street and a campus, and of the connections between these things, it would begin to throw up interesting innovations and solutions to issues that arise particularly in places such as Tower Hamlets, which are very much to do with dentistry.

I have to say that this was one of our health failures, because all that was coming together; everyone was in favour of it, and the professor of dental health was brilliant, but it sadly fell because of the politics going on in the medical school. I am illustrating it because, if we create a culture on the ground in neighbourhoods and build the relationships, these kinds of innovations around these very serious issues, which deal with the very serious medical conditions that the noble Lord, Lord Kakkar, rightly described, can start to happen.