Greater London Authority Bill

My Lords, as a long-standing and committed Londoner, I am glad to have the chance to speak on this Bill, given its aim to strengthen devolved powers in London. The main focus of my remarks will be the health provisions at Clauses 21 to 24. However, I should first declare an interest as the recently appointed part-time chairman of the new provider agency that NHS London has established. I should make clear to the House that the recent, slightly unsavoury, remarks by Front Bench spokesman for health in the other place about that appointment have been shown to be quite unjustified after an investigation by the Permanent Secretary of the Department of Health and by the Cabinet Office. As a dyed-in-the-wool Londoner, I am only too well aware of the health challenges it faces. These are brought out very well in a document published earlier this month, The Case for Change, which represents the first stage of a review by Professor Sir Ara Darzi. It reveals that although on some health indicators such as coronary heart disease London performs reasonably well, it has major challenges in other areas. For example, smoking is more prevalent in London than is the case nationally, London has higher rates of childhood obesity and it faces specific health challenges, such as HIV, drug abuse and mental health problems. London has 57 per cent of England’s cases of HIV. One in four adult drug users lives in London and a million Londoners have had mental health problems. The shortage of affordable and good quality housing in London can also contribute to health problems among its population. Health inequalities in London, both in terms of outcomes and service access, are significant. Just eight stops on the Jubilee Line take you from Westminster to Canning Town, where average life expectancy is seven years lower. Raising life expectancy for the bottom half of London boroughs to the current London average, which is pretty much near the national average, would save the lives of 1,300 Londoners every year. Infant mortality in Haringey is three times that in Richmond. Professor Ara Darzi sets out a succinct and compelling case for change that would help to tackle some of those entrenched inequalities. His document shows that providing more acute hospitals is not the answer. London already has a relatively high number of those hospitals, compared with most parts of the country. What is needed is more concentrated specialist care and better use of our workforce and buildings. However, overwhelmingly what is needed in London is a much stronger base of community and primary care services and a much greater evenness in public health polices and services across the capital. That is why it is timely for the Government to include in the Bill the provisions on health at Clauses 21 to 24, which provide for a health adviser and deputy health advisers to the GLA and a reduction in health inequalities. It is right that the GLA and the mayor have more responsibilities in this area, but it is important that they exercise them in a co-ordinated way with general public health policies and with NHS London, the body with strategic healthcare responsibilities in London. For too long, local government, particularly in relation to housing, has been something of a poor relation in tackling London’s health agenda. Some of that is down to the failure of the NHS to recognise the role that local government could play, together with the absence of a strong strategic presence for tackling health inequalities. The Bill provides a new opportunity for the GLA, the mayor and NHS London to work together for the benefit of Londoners’ health. The second and final instalment of Professor Ara Darzi’s review will appear in a few months’ time and will provide an invaluable analytical underpinning for aiding that kind of joint working. Before I sit down, I want to say a few words about waste management. There is a strong link between waste reduction and management and health and well-being. Minimising the quantity of waste and improving its collection and disposal reduces the risk of disease and injury from waste. Less money spent on waste disposal means more money for other public services. The NHS, too, has to play its part constructively, particularly in terms of clinical waste disposal and in achieving more sustainable behaviour by its suppliers. It is a big consumer of goods and services from other suppliers. I hope that the new SHA, NHS London, will play a full and constructive part in taking forward this agenda, especially in the area of clinical waste and in getting suppliers to behave in a sustainable way, drawing on the expertise of bodies such as the Environment Agency. Finally, I want to say a few words on the wider issue of waste management, speaking as a Londoner living in a borough—Southwark—which is in the dubious position of being 381st out of 393 English authorities in terms of recycling rates and which failed to meet its recycling target for 2005-06. I note in passing that the two boroughs that will be centre stage in the Olympics—Newham and Tower Hamlets—sit firmly at numbers 392 and 393. I recognise, as we have heard this evening, that the mayor’s proposal for a single waste management body did not find favour in the other place. However, in his briefing on the Bill, the mayor makes a respectable case for a more robust approach on waste management. As an experienced manager, I have to say that much of what he says makes a good deal of sense. I do not expect my noble friend to answer today but I should be grateful if she would write to me about the somewhat worrying figures that the mayor has put forward for the long-term fines that London faces for inadequate waste management. I should like to know a bit more about why the Government disagree with the mayor’s analysis and figures and why they are convinced that leaving structures as they are will deliver the improvements in waste management that London needs. In particular, I should be very interested to know whether there has been a full and proper cost-benefit analysis of the different options available.