Lord Mawson (CB)

My Lords, I, too, support the amendment in the name of the noble Baroness, Lady Royall, as well as what the noble Lord, Lord Hunt of Kings Heath, has just shared with us. Earlier, I mentioned “learning by doing” cultures. What do they actually look like? We have been engaging in depth in east London for 42 years. We have pioneered a lot of the things that we now take for granted across the country in parts of the health service, including social prescribing. We have the long view. We spent time looking up the telescope, not down the telescope from government. When you engage in a local community in depth, you soon start to discover that health and wealth are absolutely connected—they are fundamental —yet the siloed systems of the state absolutely miss what all of this might mean and the opportunities that are there in practice. The Bromley by Bow Centre, which I founded and of which I am now president, has pioneered wide-ranging approaches to these precise issues over the years. Today, we are responsible for 55,000 patients and we have built 97 businesses with local people. If they were here, our integrated health team would tell you that, on a vulnerable housing estate in the East End of London, getting a job has more of an impact on your health than anything that doctors can do in our health centre. All of them would tell noble Lords this. Yet, despite hosting 70 Government Ministers from different parties coming to see us over the past 30-odd years, when we share all this, they all say, “Yes, yes”, then go away. Nothing changes. In Bromley-by-Bow, we are still grappling with 62 different funding sources coming from the Treasury, all of which go down into different silos. We then spend a lot of money, with our staff, on putting things together around the same families. It is ludicrous. I share this with noble Lords: lessons are not being learned. In my view, the fundamental question that is being asked in this amendment is absolutely critical. This Government are starting to talk about prevention and getting upstream. I agree with all of that but, if you talk to our GPs and our team—we have 2,000 visitors a year, from all over the country, looking at our work—they will tell you that the jury is out on whether this Government are serious about joining the dots around these issues. We will go not on what they say but on what they do. As far as we can see, at the moment there is little evidence that these dots are being joined up, but, if the Government get interested in practice, there is a great opportunity for this Administration and future Administrations coming down the line. This is not a party-political matter; it is a matter for us all and for the health of the nation. In the 1990s, we realised, through practice actually, that the only way to gain scale with these kinds of issues is to start to partner with the private sector. We took these relationships seriously and today, both in east London and in a programme I lead nationally, we work with the private sector around place-making, and I declare my interests. The private sector is also concerned and interested in these questions. People in the private sector have children and families. Get to know them, dig under the carpet and create learning-by-doing cultures with them, and you will find opportunities to take these kinds of questions to scale. I support the amendment from the noble Baroness, Lady Royall, but I hope that we will move beyond amendments and yet more talk into practice and detail and get curious about what this actually looks like for local people.