My Lords, this has been a very fruitful discussion and I am most grateful to all noble Lords who have spoken. I especially thank my noble friend Lord Young of Cookham, the noble Baronesses, Lady Walmsley, Lady Thornton and Lady Hollins, the noble Lord, Lord Kakkar, and the noble Lord, Lord Patel, in his absence, the King’s Fund and the Health Foundation for their contributions, both inside and outside this Chamber, in shaping this debate and the amendments before us.
Without wishing to repeat what I said earlier, I commend the government amendments to the House as they will strengthen the ability and resolve of the health and care system to take meaningful action on tackling health disparities. I next thank the noble Baronesses, Lady Armstrong of Hill Top and Lady Morgan of Drefelin, and the noble Lord, Lord Shipley, for tabling their three amendments and for the focus they bring to the issues of housing and homelessness. I found the account of the experience in government of the noble Baroness, Lady Armstrong, and the work of Professor Aidan Halligan, whom I too remember with great respect, compelling. I agreed with so much of what she said.
Let me say straight away that the Government are committed to improving the health outcomes of inclusion health groups, as they are known. That is precisely why we tabled the amendment to expand the inequalities duty placed on NHS England and ICBs beyond simply patients to incorporate people who struggle to access health services such as inclusion health groups, but there is much more to say on this.
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We have been clear throughout our engagement on integrated care partnerships that housing and homelessness services are essential in improving poor health for
many. As my noble friend mentioned in Committee, the Bill already provides that ICPs may include the integration of those services in their integrated care strategy. We will continue to encourage the inclusion of housing and consideration of inclusion health groups in our guidance for ICPs. I hope that that is reassuring and will convince noble Lords that Amendment 65 is unnecessary.
I was very interested to hear what the noble Baroness, Lady Thornton, had to say about Bevan Healthcare. My noble friend Lord Kamall tells me that he has been a long-term supporter of a charity called Vision Care for Homeless People. It is not surprising that, with my noble friend in the Department of Health and Social Care, he and the department have been driving forward a wider agenda aimed at improving the lot of homeless people.
The noble Lord, Lord Shipley, referred to the health disparities White Paper which we will be publishing later this year. That will take a broad look at the factors that affect people’s health and will focus on the people and places facing the worst health outcomes. It will mean looking at the biggest preventable killers, such as tobacco and obesity, as well as the wider causes of ill health and access to the services needed to diagnose and treat it in a timely and accessible way. It is important to emphasise that that endeavour will not be confined to the Department of Health and Social Care; it will be a cross-system endeavour, relying on close working among the NHS, wider health and care services and across central and local government.
It is also important to mention the Levelling Up White Paper. The Government’s focus on preventing homelessness will be renewed by working across government and with local partners to tackle the root causes of homelessness, in order to make sure that the flagship rough sleeping initiative continues to provide support tailored to local areas.
The pandemic highlighted in further stark contrast the importance of integrated care and the need for key services to work closely together to support those experiencing homelessness. Integrated care partnerships will bring together the NHS, local authorities and the voluntary sector, and it will be their job to develop strategies to address the public health and social care needs of people living in their areas, including people experiencing homelessness.
Legislating for new structures is one thing, but what are the Government actually doing to improve health outcomes for people experiencing homelessness or rough sleeping? Work is going on as we speak. We recently announced in the spending review £640 million, to be spent by 2024-25, to tackle homelessness and rough sleeping. This fund will build on progress already made in this area, including support for substance misuse through the rough sleeping initiative. Through the NHS long-term plan, the NHS has committed £30 million for specialist mental health services for people sleeping rough—that is £10 million a year by 2023-24. This year, we are delivering £52 million for substance misuse treatment services for people sleeping rough, and that will fund evidence-based treatment and wraparound support, including for those with co-occurring mental health needs.
The noble Baroness, Lady Morgan of Drefelin, aptly referred to the need for comprehensive and accurate data. I quite agreed with everything she said. We initially looked very carefully at whether there was a statutory basis on which to issue guidance in this area and, in the end, we concluded that there was not. But the amendment that we have proposed requires practical steps which we believe will achieve similar policy aims.
In practice, NHS England must produce a document that sets out NHS bodies’ powers in relation to health inequalities information, together with its view of how those powers should be exercised, as I mentioned earlier. That is bolstered by a requirement for those bodies, in their annual reports, to review the extent to which they have complied with NHS England’s view. In our opinion that essentially squares the circle of the need for this crucial area not to fall between the gaps. I will of course supply the noble Baroness with any further information that I can on how those plans look like they are shaping up.
Finally, defining inclusion health groups in law is very difficult. We have therefore committed to putting a more in-depth explanation of the term in guidance, as well as advice on identifying these groups and their health needs. We recognise that the populations most at risk from health disparities may vary between localities and may change over time; that is an obvious truth. By not defining the term in legislation, we allow bodies to react to their own local and system population’s needs, as seems appropriate to them. We feel that statutory guidance is a better vehicle for helping to set out how health and care services can better identify and address the needs of these groups when drawing up the integrated care strategy.
I ask the noble Baroness, Lady Armstrong, not to move her amendments when they are reached and I beg to move Amendment 3.