My Lords, I apologise; when there are so many amendments in one group I can never work out just when people who are moving subsequent ones further down the line, as it were, ought to rise.
I will speak to Amendments 63, 65 and 67, and begin with an apology that I was not able to be here to speak to those in Committee. I too had a positive test, although I have to say that I had no symptoms. None the less, I was self-isolating, and therefore was not able to be present in the Chamber.
I welcome the amendments tabled by the Government. I chair the Public Services Committee in this House. In our first report, we looked at public services through the mirror of Covid. We noted and reported, and indeed debated in this Chamber, the significant uncovering or rediscovery of the extent to which inequalities in our society affect people’s health. I am pleased that the Government are responding with some of their own amendments.
4.45 pm
My amendments, which are supported by other noble Lords around the Chamber, relate specifically to what I understand the National Health Service calls “inclusion health communities”. For me, these are people living with complex needs in different sorts of communities. I have spent much of my working life involved with such communities and have tried to concentrate on that work in this House. The amendments seek to ensure that the NHS has a much more systematic approach to the health needs of people with complex needs and marginalised communities.
This of course involves people who have been rough sleeping—I know the Minister talked about that in Committee—but it concerns more than just that group. Those who have been rough sleeping do not have access to primary care because they do not have a settled address, but other groups are affected, such as those who have been trafficked, women who are being sexually exploited and the Gypsy, Roma and Traveller communities. The Public Services Select Committee recently held a very short inquiry into Gypsy, Roma and Traveller access to public services, which again exposed a real challenge with health and access to health services. All the data shows, and the stories from these communities tell of, very poor health outcomes, with average life expectancy being 10 to 12 years less than that of the settled community. There are some estimates which put that much higher.
As I said, I welcome the Government’s concern to address health inequalities, but having read very carefully what the Minister said in the earlier debates and in letters, it seems to me quite clear that the Government and the NHS remain behind the curve on this, I am sorry to say. I thank the sector for its briefings, which have been both moving and very useful in painting the picture of just how we are letting these communities
down. As long as we do that, we will have significant inequalities and therefore significant pressures both on and from those communities. They not only end up with poorer health outcomes but are driven to the most expensive end of healthcare. They end up in A&E because they do not know how else to access anything and normally go there far too late in whatever is going wrong with them.
I want to illustrate what I am trying to say with two different stories. I hope this will help the Minister and Members understand where we are coming from. Professor Aidan Halligan was an incredible, innovative leader in the NHS. I got to know him when I was in government and he was working in the Department of Health. He was always interested in what I was doing in tackling rough sleeping, both in the early part of my ministerial career and then when I was Minister for Social Exclusion at the end of it.
Aidan became interested in, among other things, how to get better healthcare for homeless people. He was shocked by what he encountered when he started to look at it. I agreed to chair a meeting in the House of Commons for him to bring together people to address the issue. More than 200 people turned up. That meeting and discussion inspired him to work initially with University College Hospital on developing a responsive survey. He soon set up a charity, which he appropriately called Pathway, which has flourished, to work with the NHS to ensure more responsive healthcare for the homeless. Tragically, Aidan died in 2015, but his legacy of compassionate leadership and response to the homeless lives on. Pathway teams now work throughout the country, although not, unfortunately, in every area or trust area.
The second story comes around Changing Lives, which was known as the Tyneside Cyrenians when I introduced some pilot projects from the Cabinet Office to look at a more holistic service for people with complex needs. The Tyneside group had a new model for outreach work for rough sleepers that employed people with lived experience as outreach workers. They negotiated with the local National Health Service to have a community matron attached to the team so that appropriate referral and treatment could take place.
This was the most successful pilot in the country, and when I left government I kept in contact with it. I went on its board and eventually became chair. We developed the whole organisation and did a lot more work with women. Appropriately, we changed the name to Changing Lives. We developed the principles of working with people with complex needs so that they too were involved, and getting health and other services involved at a more appropriate level than the emergency services. That initial pilot scheme demonstrated to Newcastle how much money it saved, because the “frequent flyers”, as it called them, did not end up in A&E. That is why I say that it has more to recommend it than the very important aspect of making sure that health outcomes are better for people.
Some of the subsequent work we developed through Changing Lives, particularly with those who were exploited sexually, groomed and so on, and those with addictions, has been innovative and transformative. I recommend that the Government look at how they can establish such programmes, but then make sure
that they are normal. That is the problem that these amendments address. There are some really good examples around the country where innovative charities work with the NHS to develop good practice, but by no means is that universal or automatic.
Also, Pathway and Changing Lives include people with lived experience—these days they call them “experts by experience”—in the design and delivery of the service. That makes a huge difference. I know that the Government have said that in general they are in favour of this, but they need to get hold of it to demonstrate that that can be done to a much greater extent.
I understand that the Government and the Minister are concerned about this issue, but the reality is that the Minister sought to reassure the House with measures such as Core20PLUS5. How the NHS keeps coming up with such peculiar and strange hidden titles is beyond me; it is not a phrase I use when I talk to people who have been living on the streets. Anyway, I am told that Core20PLUS5 is one programme that can be used. Then there are JSNAs. They are good and important but not sufficient to get the outcomes we need for both the NHS and the people I am talking about.
I hope that the Government will think again and see how they can systematically ensure that proper attention is paid to how we can enable these communities to access decent services. It is possible—I have tried to be positive and show that—but it must be done throughout the NHS and systematically in partnership with those people who know what it is like to have difficulty in accessing services because they have been excluded for so long. We really must make sure that we make a massive difference on tackling these health inequalities.