The Parliamentary Under-Secretary of State, Ministry of Housing, Communities and Local Government (Baroness Taylor of Stevenage) (Lab)

My Lords, I thank all noble Lords who have submitted amendments on health improvement, which is an important topic. I am pleased that we will have this duty on local authorities at mayoral combined authority and combined county authority level. As other noble Lords have said, it is an important step forward. The Government are committed to building a fairer Britain. To do that, we must ensure that people can live well for longer and spend less time in ill health. Our response, our reimagined NHS, will be designed to tackle inequalities in both access and outcomes, as well as to give everyone, no matter who they are or where they come from, the means to engage with the NHS on their terms. With our colleagues in the Department of Health and Social Care, we remain committed to reducing the gap between the richest and poorest in healthy life expectancy—an ambitious commitment that shows that the Government are serious about tackling health inequalities and addressing the social determinants of health. We support NHS England’s Core20PLUS5 approach, which targets action to reduce health inequalities in the most deprived 20% of the population and improve outcomes for the groups that experience the worst access, experience and outcomes in the NHS. As the noble Baroness, Lady Scott, said, tackling health inequalities requires a whole-government effort, as does making sure that the best facilities are available across the country. That is why we are working across departments, from housing and education to employment and welfare, to make sure that health is built into all policies and runs as a golden thread through everything taking place. I now come to the specific amendments, a number of which would make additions to the list of general health determinants. Before I turn to the individual amendments, I note that the scope and definition of “general health determinants” in the Bill has been intentionally and carefully crafted to be broad and flexible. I will write to noble Lords in answer to the questions from the noble Baroness, Lady Scott, about how those determinants have been drawn up and what consultations have been done on them. The Bill lists some of the broad and interconnected factors that shape health, life expectancy and healthy life expectancy. Combined authorities, combined county authorities and mayors can directly impact these factors, such as standards of housing, employment prospects and environmental factors, through the delivery of their wider functions. Given the importance of these factors as inarguable determinants of health, the Bill strengthens the duty and adds clarity by listing them explicitly. Although some examples are provided, it is not our intention to set out a definitive list—we feel that that would be constraining. We recognise that combined authorities and combined county authorities are experts in their local areas and are therefore best placed to decide how to determine and act on the factors most relevant to improving health and reducing health inequalities in their own areas. I am grateful to the noble Lord, Lord Addington, for tabling Amendment 158 and, as ever, for championing the importance of public access to fitness, sport and recreational facilities. This amendment would require combined authorities to consider the level of public access to fitness, sport and recreational facilities when exercising their functions. The general health determinants already include matters affecting lifestyle, access to services and environmental factors, and explicitly allow for consideration of any other matters that affect life expectancy or the general state of health. I am not being pedantic—nobody loves a clever clogs—but, to be specific and clear, I note that the amendment would apply only to combined authorities and not to combined county authorities, thereby creating inconsistency in how the duty operates. I apologise that I shall have to point that out with a number of these amendments, but it is important to clarify that. I now turn to Amendments 159 and 167 in the name of the noble Baroness, Lady Bennett of Manor Castle. I appreciate that her intention is that the health improvement and health inequalities duty, and the definition of general health determinants within the duty, are broad and impactful. A driving purpose behind the health improvement and health inequalities duty is to support combined authorities and combined county authorities in reducing health inequalities and adopting a “health in all policies” approach. The effect the amendments would have is unclear because of the potential interactions with both “health inequalities” and “general health determinants” in Clause 44. As I mentioned, the Bill has been drafted to provide a broad and flexible definition of “health inequalities” to ensure that differences in aspects such as life expectancy, general health, mental health and disabilities can all be captured in its scope. This allows combined authorities, combined county authorities and mayors to focus on the broad underlying causes of health inequalities and to tailor their responses to key local issues. Similarly, the framing of “life expectancy” or “general state of health” is intentionally broad and does not exclude mental health, disability or healthy life expectancy, all of which are legitimate dimensions of what one might regard as health and are reflected in mainstream methods for describing health states or health impacts. I turn now to the large group of amendments: Amendments 159B, 160A, 161A, 163A, 163B, 165ZA, 165B, 167A, 167B, 167C, 167D, 167E, 167F and 167G. I am grateful to the noble Baroness, Lady Freeman of Steventon, for her diligence in tabling them and recognise her assured intention to ensure that the definition of general health determinants reflects academic research and is impactful. As drafted, the list of general health determinants already requires combined authorities and combined county authorities to have regard to environmental factors, employment prospects, earning capacity and access to public services, and explicitly allows for consideration of any other matters that affect life expectancy or the general state of health. Health inequalities are already defined within the duty as inequalities between people of different descriptions living in an area, and it is therefore not necessary to restate this within the general health determinants.