My Lords, it is a privilege to open this debate on the issue of health inequalities. I am grateful to all noble Lords who have gone through the Bill to ensure that addressing health inequalities is absolutely central. Unless the Bill deals with the kind of inequalities that the pandemic, for example, has brought into sharp relief, it will have failed. Many amendments in this group directly and indirectly address the issue, and I look forward to the many contributions we will hear. This is one area where our NHS may not be among the best in the world. In fact, inequality is often entrenched. Some might argue that, through the famous inverse care law, it even makes things worse. As with other public services, the better-off, with better connections and sharper elbows, get more out of a service than those with less social capital who are already disadvantaged by other factors.
A report published today by the Northern Health Science Alliance, a health and life sciences partnership between the leading NHS trusts, universities and academic health science networks in northern England, says that
“people in ‘left behind’ neighbourhoods are 46 per cent more likely to have died from the virus than those in the rest of England, and 7 per cent more likely to have died of the virus than those living in other deprived areas”
that are not left behind. In left-behind neighbourhoods,
“Men live 3.7 years fewer and women 3 years fewer than the national average,”
and
“men and women can expect to live 7.5 fewer years in good health than their counterparts in the rest of England.”
Tackling the health inequalities facing local authorities of left-behind neighbourhoods and bringing them up to England’s average could add an extra £29.8 billion
to the country’s economy each year. The co-chair of the All-Party Parliamentary Group for “Left Behind” Neighbourhoods, the right honourable Dame Diana Johnson, said that:
“Every person in the country deserves to live a long life in good health”,
but this new research demonstrates that this is not currently a reality.
We are all aware of the work of Sir Michael Marmot. In his review, which explored the changes since 2010, he highlighted five policy areas:
“—Give every child the best start in life —Enable all children, young people and adults to maximise their capabilities and have control over their lives —Create fair employment and good work for all —Ensure a healthy standard of living for all —Create and develop healthy and sustainable places and communities”.
The key messages from that review make stark reading. This is one of the strongest:
“The amount of time people spend in poor health has increased across England since 2010. As we reported in 2010, inequalities in poor health harm individuals, families, communities and are expensive to the public purse. They are also unnecessary and can be reduced with the right policies.”
In a note that I think all noble Lords will have received from Crisis and other voluntary organisations, they point out that, as it stands, people who experience the most extreme health inequalities, such as those who are homeless, sex workers, Gypsy, Roma, Travellers, vulnerable non-UK nationals and people with substance misuse issues, encounter significant barriers to accessing and receiving the healthcare that meets their needs. These barriers can include stigma, the lack of a fixed address or ID, fragmented services, the lack of continuity of care because of unstable accommodation, and lack of awareness from healthcare professionals of specific needs.
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These can be reduced by the right policies and the right action. Health inequalities are not inevitable. Evidence shows that a concerted approach, implemented through the NHS and wider policies to address socioeconomic causes of poor health, can make a difference. The most recent national cross-government health inequality strategy was successful in narrowing the life expectancy gap between the most and least deprived communities. But I am afraid it was scrapped in 2010, and since then inequalities have widened as improvements in life expectancy have slowed.
The Bill offers a potential route to strengthen action on health inequalities, and there are three ways to improve the Bill: first, strengthening the existing core of inequalities duties; secondly, boosting the triple aim; and thirdly, ICS structures facilitating greater action on health inequalities. This suite of amendments addresses most of those.
Without doubt, healthcare should have the strongest role in tackling inequality and, in that, the strongest role should be played by public health. It is the part that has not been lucky enough to receive at least some protection from austerity, as the NHS did. Some of the unintended but inevitable consequences of the failure to invest in public health have been seen in the pandemic. Cuts have their consequences, and we have all been suffering them.
We cannot avoid, in a debate about inequalities, reference to the report An Avoidable Crisis, an investigation by my noble friend Lady Lawrence into why black, Asian and minority-ethnic communities were dying at a disproportionate rate during the pandemic. It was immediately apparent that the impact on people’s health was inseparable from economic prospects and experiences of discrimination. She says:
“It will require systemic solutions to systemic problems. It is not enough for policymakers to know that ethnic inequalities exist. We need to honestly confront how inequalities at all levels of society have come to exist and the intersectional impact it has on each ethnic group. This means recognising the interaction of faith, class, gender, disability, sexuality, ethnicity and culture in order to truly understand that no community is ever one homogeneous group.
Only then will we be able to respond effectively. We need bold, joined-up policies and an approach that encompasses tackling ethnic disparities, from housing to employment and health.”
Reducing health inequalities is not an ideological or moral standpoint; it is now well accepted that an unhealthy population is less productive, and there is a loss of economic efficiency and we all lose. The Bill offers us an opportunity to start to remedy that situation.
Those who have been lucky enough to go through the proceedings of the Bill Committee in the Commons will have seen that the Government accept the need to focus on reducing inequalities but claim that this is already a requirement expressed elsewhere in legislation. Because at present this is largely an NHS Bill, many amendments seek to make it a comprehensive health and care Bill. Only when mental health, public health, primary care and community care are all working in collaboration will we actually tackle health inequalities. I beg to move.