Greater London Authority Bill

My Lords, I am very pleased to support the government amendments in this group and to follow on from the very clear and communicative explanation of the noble Lord, Lord Low, of how important a health inequalities strategy is for disabled people living in London. I also thank my noble friend for her support on this issue. We need to be clear that the Bill is not about giving the Mayor of London additional powers in relation to the delivery of NHS services, and I think we have made that clear, so I am not going to go on about it. I will respond to the noble Baroness, Lady Hamwee, on her point about mayoral control, particularly over boroughs. The Mayor has no power over the boroughs as a result of the health inequalities strategy, as described in the Bill. He will, all being well, implement the health inequalities strategy through persuasion, influence and negotiation. Amendments Nos. 40 and 46 respond to the amendments proposed by the noble Baroness, Lady Hamwee, in Grand Committee. Amendment No. 40 adds the London boroughs to the list of bodies and persons whose role in implementing health inequalities strategies on behalf of the Mayor must be described by the Mayor. This is a sensible change, because the boroughs will have an important role in implementing any health inequalities strategy. Including boroughs on the list means that they will be consulted at the early stages of the development of the strategy, which I think is what the noble Baroness and the noble Lord, Lord Low, were keen to achieve. Amendments Nos. 43 and 45 clarify the definition of health determinants. The amendments result from concerns that were raised in Committee, and move the qualifying words, "““that are or may be harmful to health””," to a different position in the clause. I know that the noble Baroness, Lady Hanham, was concerned about the clause, and I hope that we have addressed that concern and that Amendment No. 44 will not be necessary. Amendment No. 33—an important amendment—and its series of consequential amendments change the name and scope of the strategy. That is a significant change, and the suggestion from the amendments is that the changes would result in a strategy that covers the whole of public health. I make no apology for stressing the importance of the Mayor’s strategy on health inequalities. We must not look at the health inequalities strategy in isolation, because the Mayor has other health-related responsibilities, which I will address in a moment. As we have heard so eloquently from the noble Lord, Lord Low, and my noble friend Lady Turner, health inequalities within boroughs and among different groups are stark. Right here in Westminster, you can expect to live nine years longer if you are fortunate enough to live in one of the borough’s more affluent wards than if you happen to live in one of the poorest. Boroughs and PCTs are working to address health inequalities, but they could do a whole lot more with the support that a formal health inequalities strategy from the Mayor would bring. Employment, for example, is known to improve mental health. Pan-London work supporting local efforts to get people with mental health problems into work, with the London Development Agency and employers, is therefore welcome. For that to be further promoted by the Mayor has to be positive. The Mayor already has broader health duties set out in the 1999 Act. That is why it is very much appropriate that we are now adding to that Act and bringing in a new focus on health inequalities. Little would be gained from a broader public health strategy, because many of the pan-London strategies for other public health issues which I know the noble Baroness is concerned about, such as emergency planning, pandemic flu, TB and sexual health, already exist. I hope that I can reassure the noble Baroness that that work is going on. She almost knew that I would say that, in fact, the regional director is responsible for many of these strategies and, through her relationship with the Mayor as health adviser—which will soon be formalised, we hope—she has ensured that the Mayor has been involved where appropriate. She has also supported the Assembly playing a part in the scrutiny of these strategies, because she advises the Assembly as well as the Mayor. If the Mayor were to have a broader public health strategy, it would mean widening his responsibilities to include areas currently led by the NHS and other bodies. I do not think that that is what we are talking about today. Amendments Nos. 46H and 46J are in line with proposed amendments to remove the focus on health inequalities from the strategy. I resist those amendments. I have already explained my justification for the focus on health inequalities and why we need to make changes to health determinants. I hope that, given that further explanation, noble Lords will not press their amendments.