Clause 4: Reducing inequalities
Amendment 6 moved by Baroness Jones of Moulsecoomb
6: Clause 4, page 3, leave out lines 22 to 29 and insert—
“1C Duty to improve public health and reduce health inequalities(1) The Secretary of State must, in exercising functions in relation to the health service—(a) take all reasonable steps to improve the health of the people of England and prevent illness,(b) reduce health inequalities between the people of England,(c) take all reasonable steps to reduce inequalities in the ability to access health services and in the outcomes achieved through the provision of health services, and(d) address the social, economic and environmental determinants of health, including in relation to housing, education, employment, income and environmental conditions.(2) In discharging the duties under subsection (1), the Secretary of State must take account of the need to prevent ill health by addressing its causes, as well as by providing services for the treatment of illness.”
Member’s explanatory statement: This amendment strengthens the Secretary of State’s duties to improve public health and reduce health inequalities, including by addressing the social, economic and environmental determinants of health and preventing illness rather than relying on treatment alone.
Filling in for Natalie on day 1 of Committee Stage: I will speak to the four amendments in this group that are in the name of Lady Bennett of Manor Castle. I shall speak also on behalf of Lady Whitaker, who is ill and unable to be here. She asked me particularly to mention that she supports Amendments 15, 16 and 17 in this group, on inequalities.
On Amendment 6, a duty of “must have regard to”, as is currently in Clause 4, is not much of a duty. We can have regard to many things, but it does not mean that we will do anything about them. I support the amendments in this group that want to strengthen that duty to something where we can see some action. The aim of this amendment is to strengthen it further and to put improving public health, reducing inequalities and addressing the social, economic and environmental determinants of health into the Secretary of State’s statutory responsibilities.
We talk a great deal about the pressure on the NHS. We talk about waiting lists, hospital capacity, workforce shortages and the money needed keep services going. These are all extremely important, but we need to ask some more fundamental questions. Why are so many people becoming ill in the first place, and why are some people so much more likely to become ill than others? As the noble Lord, Lord Crisp, said on an earlier group, we need to shift our focus from treating sickness to creating health. Health is not simply a matter of what happens when somebody walks into a GP’s surgery or a hospital. It is shaped by conditions in which people are born, grow up, work and live. It is shaped by whether somebody has a secure home, a decent income, good food, good education, safe working conditions and clean air to breathe.
These things should make up a health policy. A person living in a cold, damp home, especially near a busy road, as so many people do here in London, is more likely to suffer from respiratory problems. Someone who cannot afford nutritious food faces consequences for their lifelong health. A child growing up in poverty can face disadvantages that will affect their health for the rest of their lives. This amendment takes all that into account and would require the Secretary of State to take reasonable steps to do something about it, because here in the UK, those in the most deprived areas can expect to live almost 20 healthy years fewer than those in the least deprived areas. That is a staggering statistic.
Prevention will not eliminate the need for hospitals, medicines or specialist care, but a health service should not focus just on what happens after people become ill. Prevention means more than telling people to make healthier choices. It means making those choices possible. It means tackling food poverty and ensuring that people can afford nutritious food. It looks like investing in public health and early intervention. There is not much point in treating the consequences of poverty without addressing the circumstances that make people ill.
What is the point of treating respiratory disease while allowing people to live in damp homes or to breathe polluted air? Human health and the health of the natural world are connected. Cleaner air and water, access to nature, healthier food systems and action to protect us from the effects of the climate crisis are all public health measures. As we know, the benefits of a healthy environment are not shared equally. People on lower incomes are often least able to move away from pollution, poor housing and unhealthy surroundings. The inequalities that we see in health are therefore connected to inequalities in wealth, power and the quality of places where people live. Lady Nargund, also spoke about inequalities, a primary pressure on our beloved NHS.
The gap in healthy life expectancy between the most and least advantaged communities is a measure of inequality that the Government should actively try to reduce. A statutory duty will not by itself remove these inequalities, but the wording of a Bill does matter. It establishes what the Government are required to do rather than merely saying what they would like to do.
Amendments 15, 16 and 17 aim to strengthen the provisions in Clause 4 for all communities facing health inequalities. These amendments address three essential requirements—visibility in health data, recognition in decision-making and accountability for progress. For example, Gypsy, Roma and Traveller communities experience some of the most severe and persistent health inequalities in England. They face poorer physical and mental health, barriers to accessing healthcare and discrimination within healthcare settings. The 2021 census found that Gypsy or Irish Traveller people were more than twice as likely to report bad health or very bad health as the rest of the population of England and Wales overall—12.5% compared with 5.2%.
Nearly one in six reported being disabled and limited “a lot” in their daily activities by long-term physical or mental health conditions, compared with around one in 13 of the overall population. Research has found that Gypsy or Irish Traveller women in England and Wales are twice as likely to die by suicide as those in the white British women category. Yet a 2020 review by Friends, Families and Travellers found that of 79 local suicide prevention plans covering 113 areas in England, only five mentioned Gypsy and Traveller communities, and only two included action to address suicide inequalities.
Therefore, despite the inequalities in health outcomes, the communities’ needs are not being consistently identified in national health data or adequately reflected in the planning and delivery of services. Collecting properly disaggregated ethnicity data is essential. Gypsy, Roma, and Traveller communities are not a single homogenous group, and grouping them together under one category can obscure important differences in their health experiences and outcomes. Data should enable us to understand the distinct experiences of Gypsy, Roma, Irish Traveller and other communities, rather than masking inequalities within broad categories.
More broadly, the same challenges affect other inclusion health groups, including people experiencing homelessness, vulnerable migrants, people in contact with the criminal justice system, and victims of modern slavery. These groups often experience overlapping disadvantages, social exclusion and barriers to healthcare. Clause 4 provides an important opportunity to address these inequalities but, as it stands, a general duty to “have regard to” reducing inequalities and access to health services and health outcomes will not, by itself, ensure that the people experiencing the greatest inequalities are identified, considered and supported. These amendments would help make that duty effective in practice.
Amendment 15 would require national health data systems to collect, analyse and publish data sufficient to identify and monitor these inequalities. Amendment 16 would ensure that the particular barriers facing inclusion health groups are considered when the Secretary of State exercises the health inequalities duty. Amendment 17 would require annual reporting on progress, including action taken in relation to Gypsy, Roma, and Traveller communities—this is essential for transparency and accountability. These amendments are all complementary. They would help ensure that inclusion health groups are visible in the evidence used to make decisions. They build on existing commitments to reduce health inequalities, and they aim to ensure that the system we have is better able to recognise and respond to the needs of these communities. I beg to move.
I closed the debate saying:
I thank the Minister for her replies; I really admire the positivity in there. I have been using the NHS since 1949, and it is absolutely amazing. My working-class parents were incredibly delighted by its introduction, but I rather suspect that my age cohort has had the best of it—I hope that that is not true. I would love to respond to a lot of the points, including on coastal communities, which often suffer from huge environmental pollution in rivers, along seashores and so on. This has been a fascinating debate, and I can see an exciting Report stage in the offing. In the meantime, I beg leave to withdraw my amendment.
Amendment 6 withdrawn.
