Many people recognize that both the NHS and the health of the nation are in deep crisis. Whether we look at life expectancy, levels of long-term ill-health, inequalities, mental health, or the drivers of poor health such as obesity, England’s recent record is poor and often compares badly to its neighbors.
In addition to the obvious fact that no one wants to be ill or to die prematurely, this state of affairs weighs heavily on the economy and HM Treasury, whether in terms of higher treatment costs, increased welfare payments, or the loss of potential staff to ill-health at a time when many parts of the economy are facing deep workforce shortages. The latest Office for Budget Responsibility report shows the rise in health-related economic inactivity has already added almost PS16 billion in annual costs to the economy; in this, we are an international outlier, and this particular issue will not be solved by reducing NHS waiting lists.
Therefore, it is timely that a group has come together to set out a possible path out of this mess, publishing A Covenant for Health that sets out priority areas for action, which, taken together, can make England a healthier place to live and work. If this all seems to make perfect sense, what stops us, as a country, from doing it? Four common myths have stood in the way.
First is the view that the available policy levers are ineffective or unproven. This is not the case. There have been major successes in the fight against many of the key drivers of ill health. For example, the regulation and taxation of tobacco, linked to support for smokers to give up, has been successful in driving down the number of people who smoke (though more still needs to be done). Scotland’s minimum unit price of alcohol has reduced deaths; the tax on sugary drinks has similarly had an impact on obesity; and the concerted efforts in other countries against the rise of obesity show that there are options. The list goes on. Another common claim is that these levers take so long to work that it is never in the interests of current decision-makers to bother, as they’ll all be long gone before any benefits are realized. It’s true that some actions – such as on the health of children – will pay back over a long time, but many others – such as reductions in the number of people that smoke or overuse alcohol – have an impact much faster (certainly within the lifetime of a Parliament).
…at its heart, the NHS is primarily about health care – treating illness. And it is not possible to `treat’ our way out of the current crisis by waiting until people actually get ill.
A second common error is to think this is all work for the NHS and only the NHS. It is true the NHS has a role to play and can do better in health (in detecting and treating cardiovascular disease, for example). But at its heart, the NHS is primarily about health care – treating illness. And it is not possible to `treat’ our way out of the current crisis by waiting until people actually get ill. In reality, many of the levers to take action earlier lie outside the NHS.
If it’s not for the NHS, then isn’t this just for government to sort out? The third error. Again, it is true responsibility for many powerful levers on regulation and taxation, better housing, air quality, and others lying with the government. Action by central and local governments is an essential foundation for improving the public’s health. But this isn’t something that can just be laid at the door of government or even the combination of government and the NHS. Employers, communities, and the voluntary, community, and social enterprise (VCSE) sector all have influence and can support the health of their employees, citizens, or beneficiaries.
So the new Covenant for Health looks for action across all these sectors: central and local government, the NHS, business, and the VCSE sector, in a bold commitment to improve health and wellbeing over the next 5 to 10 years.
So the new Covenant for Health looks for action across all these sectors: central and local government, the NHS, business, and the VCSE sector, in a bold commitment to improve health and wellbeing over the next 5 to 10 years. Ideally, it is a cross-party commitment that can feed into the pledges for the next general election. But here comes the last common error: surely all this will play badly with the public? A toxic mix of the nanny state and lecturing on `healthy’ behaviors? Putting aside those who, for ideological reasons, think individuals should be left to sort out their health (which is ideological given all the evidence that simply providing evidence to people on health impacts does not change their behaviors), this isn’t true. Of course, there can be steps that are, or appear to be, unpopular when introduced, but these quickly become part of the status quo; as George Osborne said this year, `no one now would reintroduce smoking in pubs, and no one now would say you shouldn’t wear a seatbelt.’ In many other areas, the public is perfectly aware of how important a good diet, exercise, and mental health are but also recognizes the need for help to make the right decision and to have help to make the healthier choice when, all too often at the moment, it’s the unhealthy option that is cheaper, easier or more convenient.
The need for action to improve the nation’s health is stronger now than at any time in my long career in health and care. Fortunately, the evidence base for successful levers to make improvements is also stronger. Leaders need to raise their sights above the current operational crisis in the NHS and the travails of cost-of-living pressures and industrial action elsewhere. Our very failure to improve health is making those short-term pressures worse, harming the economy and the health of our nation.