Health and Care Bill

Lord Mawson Excerpts

Lords Hansard - Part 1 & Committee stage
Thursday 13th January 2022 Lords Chamber

[Lord Mawson (CB)]

My Lords, I did not want to speak in this part of the discussion but I will make a few comments. I absolutely support what the noble Baroness, Lady McIntosh, and the noble Lord, Lord Howarth, have been saying.

When I first arrived in Bromley-by-Bow 37 years ago this year, I found on my doorstep the largest artistic community outside New York and none of the systems had even noticed or understood its significance. Over the last 37 years, we have been exploring the whole arts and health agenda and the massive impact it can have on local people’s lives.

When we began to put the Olympic project together —as I said on Tuesday, I was involved in it from day one for 19 years—we took that really seriously and engaged with that large artistic and creative community in health, jobs and skills, education et cetera. That £1.2 billion development going on at the moment in the middle of the Olympic park, bringing together University College London, the London College of Fashion, Sadler’s Wells, the V&A, the BBC orchestra and others, is all about this innovation agenda. It is moving it to scale. If this is to happen, we need the systems of the state and the public sector to learn from this entrepreneurial behaviour, which is happening on the ground, in real places and now to scale, and to understand the detail of what it means for the macro systems of the NHS.

I will say more about place later today, but I thank the noble Baroness for making those points, and the noble Lord, Lord Howarth, because this is fundamental. It relates to the fundamental question: what is a human being? A human being is fundamentally a creative being. Health and creativity and, I suggest, entrepreneurship and doing things, are fundamentally connected.

[Lord Bethell (Con)]

My Lords, I came face to face with the nation’s health inequalities every morning in the departmental Covid response group, the COBRA meetings and the COBRA gold, when we went through the hospitalisation details and ICU data and heard stories from the front line of how people who had comorbidities particularly associated with obesity were filling up our hospitals as the virus spread through the country in wave after wave. That health inequality hit this country hard in very real terms. It cost a lot of lives, caused a lot of misery and cost our health system an enormous amount of money. It cost this country and its economy a huge amount of money and it is time that we came to terms with that challenge and solved the problem.

As a number of noble Lords have pointed out, the NHS must step up to its responsibilities in this area. There are complex reasons for these inequalities; some are environmental, some are behavioural and some are to do with access. But the NHS and whole healthcare system must realise that it needs to be involved in all aspects of those, and prioritise and be funded accordingly. The Bill already does an enormous amount to change the healthcare system’s priorities. Putting population at the heart of the ICSs is one really good example of that.

To anticipate some of his remarks, I know that the Minister will point to the Office for Health Improvement and Disparities. As the noble Lord pointed out, however, it has a tiny budget and cannot take responsibility for the nation’s health. Our councils are stony broke, as I found in my experience of dealing with them over the last two years. There is no one else to do this; this is not someone else’s problem. This is to do with the British healthcare system, and it needs to stand up to that responsibility. Zero progress has been made in the round over the last few years and we have gone backwards in the last two years in a big way. We need to make this a massive priority.

This is a fantastic Bill; I am really supportive of it. It came from the healthcare system originally. In this one area, however, there is a graphic lacuna that needs to be addressed. The noble Lord, Lord Kakkar, put it so well in his inimitable way. The prioritisation of inequality must be put in the Bill and it needs to be heard throughout the healthcare system that this is the new, central priority that needs to be added to everyone’s job description.

If, for some reason, we do not do that there will be huge consequences. The healthcare system is unsustainable in its current form. We cannot continue to have a large part of the population carrying grievous comorbidities or disease and afflictions which are undiagnosed or not properly mended turning up in our hospitals at a very late stage and costing a fortune to mend. These health inequalities, whether they relate to disease, injury or behavioural issues such as obesity, are costing us a fortune. Only by putting tackling inequality on the face of the Bill can we really give it the priority it deserves.

I also say to the Minister that there is a sense of political jeopardy about this as well. We went into the last election committed to levelling up on health. We have gone backwards in the last two years through no fault of the Government, but if the Government do not step up to their responsibilities in this area, and if the NHS and the healthcare system do not change their priorities, the voters will judge us extremely harshly. For that reason, I urge the Minister to listen to this debate and look very carefully at ways of amending the Bill.