Levelling Up?

This is Hansard’s record of my speech in yesterday’s Committee stage debate in the House of Lords as we began line-by-line scrutiny of the Levelling Up and Regeneration Bill. All amendments, having been debated and responded to by the relevant Minister, are by convention then withdrawn so that the government can take back the content of the debate and decide whether the text of the Bill might be amended before bringing a (hopefully) revised text at Report Stage.

My Lords, at Second Reading, I remember applauding, broadly speaking, the ambitions of the White Paper. However, I share the concerns of the right reverend Prelate the Bishop of London, who of course brings to this much more experience than I do.

I am pleased that, already, the noble Baroness, Lady Hayman, has alluded to the interconnectivity of all these different missions; they cannot be seen in silos or in isolation. For example, if you have children who are turning up at school unfed or living in poor housing, you can try teaching them what you will but it may not be very successful, and that has an impact not only on individuals but on communities and their flourishing.

I will speak to Amendment 15, tabled by the right reverend Prelate the Bishop of London, and briefly to Amendments 7, 30 and 31.

Health disparities require discrete attention in the Bill. It is not an optional extra. The Bill as it stands states the missions but does not provide mechanisms for action or accountability. How will we be able to measure whether they are effective or not? The right reverend Prelate the Bishop of London has said that, although assurances by the Minister are very welcome, they are not enough; they have to be backed up in the Bill with measurable implementation gauges.

Good health is key both to human—that is, individual—and social flourishing. As I said, we cannot separate out such things as housing, education, health, transport and so on as if we can solve one without having an impact on the other. However, there are inequalities between the regions in many of these areas. I speak from a context in the north: the whole of west Yorkshire, most of north Yorkshire—but do not tell the right reverend Primate the Archbishop of York that—a chunk of Lancashire, one slice of County Durham and a bit of south Yorkshire. The inequalities are serious. The economic squeeze, in the words of the right reverend Prelate the Bishop of London, is an incubator for inequalities, and we know the impact that inequality has across the board.

The White Paper rightly recognises the centrality of health to levelling up, but the actions by which this will be achieved could be argued to be lacking—and we certainly need long-term solutions and not quick fixes or slogans that sound good but do not lead to content. Can the Minister therefore offer assurances of the Government’s commitment to health within the levelling-up agenda in ways that can be measured and accountability upheld?

I support Amendment 30, in the name of the noble Lord, Lord Holmes of Richmond. The Government must give formal consideration to the inclusion of social prescribing. Why? Because social prescribing recognises the social determinants of health and the importance of community in improving health at every level. There are good examples already of where this is being explored, such as the National Academy for Social Prescribing, and I endorse the comments of the noble Baroness, Lady Grey-Thompson, at Second Reading in this regard. There are examples of services run by faith and community groups in London and beyond, and the pilot by the DHSC in Wolverhampton is promising. The key to all of this is the relational dynamic in the well-being of both individuals and communities. This leads me to ask how social prescribing might be used to tackle inequalities in health and well-being. I hope that the Minister will be able to respond to that.

I turn briefly to Amendments 7 and 31. The text of the missions might be important but we need evaluative measures in the Bill so that they can be measured. Otherwise, they are merely aspirational and all we can do is trust the word, however well-meaning, that is applied to it. Moreover, how can the Government be held to account on delivery? Commitment to the missions can be measured only by some process of assessment on implementation, and this needs to be in the Bill.

I conclude with the obvious statement that healthy life expectancy is surely a key measurement of our effectiveness in tackling health inequalities.

 

The health of Sudan (Sudan 5)

It might seem an odd choice of reading material on a trip to Sudan, but I have just finished Simon Jenkins' A Short History of England. Excellent stuff – a romp through the kings and queens and politicians of England since before England existed. The book cover also calls it 'The complete story of our nation in a single volume'. Er… I think there might be a slight discrepancy between 'a short history' and 'complete story'! Anyway, it is a great quick read and fills a gap.

The reading also offers a little relief from the insistent questions surrounding and arising from almost everything else we are doing and everywhere else we are going here in Khartoum. Yesterday we were taken to visit the Abu Rof Clinic in a poor area of Omdurman. The Administrator showed us round and the ordered goodness of the place was evident at every turn. This clinic, run by the church, reaches people not being reached by anyone else. They do basic health education, lab tests, nutrition advice and resourcing, counselling and other medical and pastoral care. The scope is remarkable.

The main ailments among children here are TB, skin diseases and digestive problems, mainly caused by malnutrition, poor hygiene and poor understanding of health basics. Adults are increasingly showing up with HIV as well as similar illnesses to the children. Women are taught about birth control (not using contraceptives). The most surprising discovery of the visit so far was the moringa tree – the leaves provide amazing amounts of vitamins and minerals and can be dried, crushed and sprinkled on other foods. Brilliant! So, the clinic not only grows its own, but it also enables people to have their own to grow so they have an endless supply of nutritional elements at no cost.

However, the visit was also poignant. Two Swiss nurses have been told to leave the country and the second leaves tonight. After 24 years he in this clinic, this seems an almost absurd move that can only harm the people whom the government (presumably) wants to help in terms of health care. This sort of expulsion is not uncommon and other stories can be told later.

I might be wrong, but it seems that (particularly) the vote to create the new state of Southern Sudan has led the government of Sudan to make southerners accept the consequences of their vote: you wanted your own country; now go and live in it. So southerners are being asked to go south. This is, in one sense, entirely understandable (if not entirely defensible) in terms of making people accept responsibility for the choices they have made. Foreigners with connections to the churches are also being told to leave. The overall drive seems to be to create a single country with a single culture and a single religion – and this process is, of course, enhanced by the drive to have a single language, Arabic. Hence the problem with the marginalization of the Nuba (Africans) and the continuing attrition in the Nuba Mountains.

First impressions should never lead to final conclusions. However, the picture is beginning to build and I am understanding more each day of why things are developing the way they are. I will need to think it through once we have returned and then see where the dust settles.

Today we have a meeting with the British Ambassador before heading into the suuk for yet another new experience. Given that I loathe any form of shopping anywhere, this might have to be seen as a 'cultural experience'.

 

Posted with Blogsy

 

Doing Europe in 6 days

Here in England we shake our heads at groups of American tourists who tell us that they are ‘doing Europe’ in a week. Saying ‘I’ve been to Austria’ is not quite the same as spending time with Austrians and learning how they tick – especially if ‘Austria’ looked like a whizz through The Sound of Music and its singing nuns up a mountain.

But, if that sort of tourism does the European head in (so to speak), there is one version of ‘doing Europe’ that I am enthusiastic to commend. Yesterday John Hale and Andy Thomas set off to ride their motorbikes through 12 European countries in 6 days. They are not doing it for fun – it will mean hard driving for around ten hours each day – but to raise cash for buying and equipping motorbikes to be used in health work in Zimbabwe. I waved them off outside a shop in Croydon from a standing position: one thing you will never get me on is a motorbike…

John and Andy left Croydon in the early morning yesterday and they aim to raise £20,000 towards the building of a workshop in Harare which will form the base for the maintenance and supply of small motorbikes for health workers. Great idea for an achievable goal.

Their progress can be tracked by GPS from the www.12in6.org website and money can be donated through www.justgiving.com/12in6. So far just over £11,000 has been raised. It would be brilliant if the goal had been reached by the time the two blokes get back from France, Belgium, Luxembourg, Germany, Switzerland, Italy, Austria, Slovakia, Hungary, Slovenia, Czech Republic and the UK.

Although a bike fan since he was 14, John is motivated by another factor. He and his wife, Lynne, lost their 17 year old son, Chip, in a bike accident in Croydon two years ago and it was the shock of this that started thm thinking about things. As a result they started working with Riders for Health to raise money for their projects in Africa.

I will be in Zimbabwe in early August visiting Harare, Gweru and other places and hope to drop in on this project to take some pictures. It would be great if the workshop was up and running. We’ll see.