My Lords, I add my warm congratulations to the noble Lord, Lord Stevens of Birmingham. There is much to welcome in the Bill—but not Clause 140, which, by excluding local authority support from the calculation, means that poorer people will lose a larger proportion of their assets in paying for social care. Especially coming on top of the regressive national insurance levy, this is shockingly unfair. I also share the concerns expressed by noble Lords about the effectively untrammelled power that Clause 39 provides for the Secretary of State.
I strongly support the restriction on advertising of food and drink. It is right to curb abuses of commercial and media freedom by food and drink manufacturers that seek to wreck human health for their profits.
I very much welcome the centrepiece of the Bill: the replacement of the driving principle of competition with that of collaboration—not only between bodies within the NHS but between the NHS, local government
and other community partners—and the statutory underpinning of place-based integrated care systems. While the Bill hardly begins to address the really big challenges for the NHS—integration of health and social care, workforce planning, prevention and health inequalities—ICSs point the way to making progress on all these.
I would like to describe one way in which some ICSs have already entered into fruitful partnership with non-clinical bodies. I declare an interest as chair of the National Centre for Creative Health, a charity that promotes creative engagement with the arts and culture in the interests of health and well-being. It was set up in response to a recommendation in the 2017 report Creative Health by the All-Party Parliamentary Group on Arts, Health and Wellbeing. A number of noble Lords took part in that work. The NCCH is working with NHS England and four ICSs: Gloucestershire; West Yorkshire and Harrogate; Shropshire, Telford and Wrekin; and Suffolk and north-east Essex. Our focus is on how cultural and community assets can mitigate the negative health impacts of social disadvantage.
Creative Health set out a mass of evidence on the health benefits of creative activity. It also demonstrated significant benefits for the health and well-being of NHS staff. Since 2017, the body of evidence has increased, as reported in the work led by Dr Daisy Fancourt at UCL for the World Health Organization and for the MARCH Network, funded by UKRI. There have been numerous other testimonies concerning the benefits of the arts for mental health during the pandemic. ICS leaders who have recognised this have been enthusiastic to work with the NCCH and local arts bodies to realise the potential of engaging creativity to further their health agendas, whether in preventive strategies or in assisting patients to recover better. Significant innovative work has been taking place—for example, in Suffolk, where sufferers from long Covid are being supported to improve their breath control through singing.
Psychosocial factors that contribute to health inequalities include isolation, lack of social support and social networks, lack of self-esteem, perceived lack of control, and doubt about the meaning and purpose of life. Engagement in music, dance, drama, pottery, art classes or reading groups can mitigate all those factors.
There are two aspects of the Bill on which I would be grateful for the Minister’s clarification and reassurance. Will integrated care boards have the freedom to include in their membership nominees of community bodies such as arts and cultural organisations, and will new procurement regulations permit ICSs to buy non-clinical services from arts and cultural bodies and individuals?
Professor Sir Michael Marmot endorsed the findings of Creative Health in these words:
“The mind is the gateway through which the social determinants impact upon health, and this report is about the life of the mind. It provides a substantial body of evidence showing how the arts, enriching the mind through creative and cultural activity, can mitigate the negative effects of social disadvantage.”
Of course, the Marmot agenda is far broader. The Marmot review estimated in 2010 that health inequalities cost £31 billion in lost production. The Treasury should recognise the investment case for fully resourcing ICSs.
More than that is needed. Until the Government mobilise other departments alongside the Department of Health to address systemic environmental and social factors in local communities across the land, there will be no levelling up, poorer people will continue to suffer unnecessary ill health, and the NHS will continue to struggle.
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