Health Bill

Debate between Lord Mawson and Lord Kamall

Committee stage
Wednesday 11th November 2026 Lords Chamber

[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.