Briefing: English Devolution and Community Empowerment Bill, Report Stage, Monday 24 and Tuesday 25 November

The Health Foundation has worked with partners, including the Local Government Association, Centre for Local Economic Strategies and Health Equity North, on a set of amendments which we have tabled to the Bill:  

1. Amendment 172 – tabled by Luke Myer MP: This amendment would strengthen the proposed health duty (Clause 43) by requiring Strategic Authorities to create a health inequalities strategy and to report on progress every five years.  
    
2. Amendment 173 – tabled by Luke Myer MP: This amendment would strengthen the proposed local growth plans (Clause 38) by including a requirement to improve health and reduce health inequalities. 
    
3. Amendment NC73 – tabled by Helen Morgan MP: This amendment creates a new reciprocal duty to cooperate within an area: between Strategic Authority, local authorities and other public service partners. 

This Bill provides an important opportunity to improve health and address persistent economic, health and other inequalities both within and between regions. These amendments are intended to ensure the Bill achieves this potential and are deliberately light-touch and enabling. They build on existing legislation and practice, such as the Greater London Authority’s statutory duty to produce a health inequalities strategy by providing a proportionate framework and accountability to ensure the new health duty, local growth plans and the reciprocal duty to collaborate, lead to measurable improvement without adding unnecessary bureaucracy or central prescription. 

The case for action 

The UK’s health is fraying and compares increasingly poorly with our international peers. Research we published earlier this year showed that improvements in UK mortality rates slowed significantly in the 2010s, more so than in comparable high-income countries, with the working age population particularly affected. Of the 21 countries studied, only Canada and the United States experienced a similar worsening of mortality rates among 25-49 year olds. Some UK regions fared much worse than others, particularly the North East and North West, where mortality rates are 20% higher than in the South West. This underlines the deep health and regional economic inequalities that exist between different parts of the UK.   

The economic impact of our poor health is stark. 8.2 million working-age people report a long-term health condition that limits their ability to work, while poor workforce health is estimated to cost UK employers up to £150bn a year through lost productivity, sickness absence and recruitment costs. Our analysis projects that an additional 2.5 million people will be living with major illness by 2040, with 80% of the increase in the number of working-age people living with major illness concentrated in more deprived areas.  

Much of the action to rebuild the UK’s health needs to be delivered at regional level through economic development and by creating healthy places. This gives Strategic Authorities a unique opportunity to take the urgent action needed to improve health, reduce inequalities and boost prosperity for all.   

The government has also stated in the Bill’s explanatory notes that the new health duty will support the government’s health mission. We strongly support the mission-based approach to improving health, which requires long-term, cross-government action to address the wider determinants of health. Our amendments are designed to ensure that the Bill plays its part in improving health across the regions in England.  

Tabled amendments   

Amendment 172 – tabled by Luke Myer MP 

Purpose: This amendment provides a clear mechanism for implementation and accountability of the health duty (Clause 43) while maintaining local flexibility. It mirrors existing practice in London and ensures health and wellbeing are embedded across all strategic functions. 

Supported by: The Health Foundation, the Centre for Local Economic Strategies and Health Equity North 

Text of amendment 

Clause 43, page 45, line 11, at end insert—  

“107ZBA health inequalities strategy  

1. Each strategic authority must prepare and publish a health inequalities strategy setting out how it will operationalise the duty under section 107ZB.
2. The strategy may be a standalone document or incorporated within another statutory or strategic plan of the authority.
3. The strategy must promote health improvement and the reduction of health inequalities between persons living in the strategic authority area.
4. In preparing the strategy, an authority must have regard to relevant national and local strategies relating to health improvement and the reduction of health inequalities.
5. The strategy must set locally appropriate targets and policies designed to meet them, set for the end of a 10- year period beginning on the day on which the strategy is published. 
6. The metrics may include, but need not be limited to metrics relating to—  
   a) healthy life expectancy,  
   b) infant mortality rate, and  
   c) poverty (including the child poverty rate). 
7. The strategic authority must, once every five years, alongside its local growth plan, produce and make publicly available a report on progress against the strategy.” 

Amendment 173 – tabled by Luke Myer MP 

Purpose: This ensures that local growth plans explicitly take account of the statutory health duty and the proposed Health Inequalities Strategy. It strengthens the link between economic growth and health improvement, complementing the government’s intention that devolution should support inclusive growth and stronger communities, while maintaining local flexibility 

Supported by: The Health Foundation, Centre for Local Economic Strategies and Health Equity North 

Text of amendment 

Schedule 19, page 214, line 30, at end insert—  

   d) take account of the statutory health duty and health inequalities strategy prepared by the strategic authority, and  
  e) promote community wealth building, cooperatives, mutuals and the wider social economy as mechanisms to narrow health inequalities.” 

Amendment NC73: tabled by Helen Morgan MP  

Purpose: This new clause introduces a statutory duty on local public service partners, such as NHS bodies, police, and fire authorities, to co-operate with Strategic Authorities and principal councils. It ensures reciprocal engagement in local decision-making, service planning, and policy implementation, strengthening whole-area collaboration across public services. 

Supported by: The Health Foundation, Local Government Association and Centre for Local Economic Strategies  

Text of amendment  

To move the following Clause—  

“Duty of local public service partners to co-operate  

1. The Secretary of State must by regulations designate certain persons or bodies as “local public service partners” for the purposes of this section. 
2. These regulations must include, at a minimum—  
   a) NHS bodies;  
   b) police and fire authorities; and  
   c) any other public service providers exercising functions in the area of a Strategic Authority, in addition to the principal councils in that area. 
3. A local public service partner operating (in whole or in part) in the area of a Strategic Authority must, in exercising its functions so far as they affect that area, co-operate with—  
   a) the Strategic Authority; and  
   b) the principal councils for that area. 
4. The duty to co-operate under subsection (3) includes, in particular—  
   a) a duty to attend any meeting reasonably convened by the mayor of the Strategic Authority under section 21 (or by the Strategic Authority acting collectively), when given due notice;  
   b) a duty to provide information and assistance to the Strategic Authority and to principal councils, insofar as reasonably required to facilitate the exercise of their functions or any joint planning of services for that area; and  
   c) a duty to engage constructively, actively and on an ongoing basis with the Strategic Authority and principal councils when formulating or implementing policies, plans and services that affect the area. 
5. In performing the duty in subsection (3), a local public service partner must have regard to any guidance issued by the Secretary of State on the implementation of whole-area public service collaboration.
6. In this section, “principal councils” means the county, district or London borough councils (including the Common Council of the City of London) whose territories lie within the area of the Strategic Authority.” 

Who we are 

The Health Foundation is one of the largest independent charitable foundations in the UK providing research, analysis and grant-funding to improve health and health care. We spend around £50 million a year on our work to improve policy and enable systemic change in pursuit of our mission to build a healthier UK. Our work on devolution, health and employment includes:  

• Our £1.3m Mayoral Regions Programme, which is working to improve health and reduce inequalities across all mayoral regions. 
• Our partnership with the Centre for Local Economic Strategies and The King’s Fund, building insights into how regional devolution can improve health and health equity. 
• Our independent Commission for Healthier Working Lives which earlier this year published recommendations for tackling the UK’s working-age health challenge.  
• Working with the Growth and Reform Network to showcase effective approaches to improve health through economic development, and how local growth plans can improve health at a regional level. This builds on learning from our five Economies for Healthier Lives partnerships in Liverpool, Leeds, Salford, Havant and Glasgow.   

Further information 

For further information or if you wish to discuss any of the issues raised in this briefing, please contact Alex Boyle, External Affairs Manager: Alex.Boyle@health.org.uk