Putting health at the heart of government
Helen Buckingham, Senior Advisor at PPL, says that as September often marks a fresh start, our government could turn over a new leaf and crackdown on reforming our health and social care sector.
It’s September and we’ve all got that back to school feeling. A new school year always feels like time for a new start, and this year we’ve got a new government too. A new government on a mission – or rather, on five missions. And although health is only referred to explicitly in the third mission, ‘to improve the NHS by reforming health and care services and reducing health inequality’, arguably putting health at the heart of government contributes to all five.
This is recognised by the World Health Organisation (WHO) which states in its Constitution that:
- ‘Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
- The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.
- The health of all peoples is fundamental to the attainment of peace and security and is dependent on the fullest co-operation of individuals and States.’
So, putting health at the heart of government is a laudable aim. But it won’t happen just because a mission statement says it should. Action will be required. But this much more than a call for action on NHS reform.
The detail beneath Labour’s mission on health focuses very specifically on ‘fixing the NHS’, and the priorities set out there for reducing waiting times and improving access to diagnostics, dentistry, GPs and mental health services are not wrong. The Darzi review shows just how much work there is to be done to fix treatment services. But getting the treatment of ill-health back to where it should be won’t in itself produce a healthy nation. We need to see government moving from the medical model of health, largely focused on the treatment of ill-health, to the bio-psycho-social model which understands that health is the outcome of the interrelationship between a wide range of factors.
Successive governments have talked for many years about the importance of investing in prevention, and this government is no different. Ensuring access to and uptake of screening services, vaccinations and advice on healthy living is important and necessary – but still won’t be sufficient to create healthy populations. Some of the most significant public health interventions in recent years have been those which might be seen as manifestations of the nanny state – the smoking ban, the sugar tax, and going further back in time, seatbelt legislation and legislation on drink driving. All of them controversial in their time, all now part of the norm. So it is positive to see that the government appears willing to use legislation as a positive lever to improve health.
But that still won’t be enough. We need to look at the fundamentals. We need government to create the conditions which enable people to make healthy choices and to live healthier lives. That means ensuring that people are living in housing which isn’t mouldy or infested, and which has both sufficient internal space and access to outdoor space, especially to natural environments. It means ensuring that individuals and families are able to buy healthy ingredients close to home at a price they can afford, and that they have both the skills and the means to cook them. It means ensuring that children have access to good education, and that they are sufficiently well fed and clothed that they are able to learn effectively. It means ensuring that adults of working age have access to meaningful employment, or access to benefits where full employment simply isn’t a viable option, for example for carers. It means ensuring that older people and people with disabilities have the support they need to continue to live full and independent lives for as long as possible.
We need a mindset which sees the assets that communities themselves hold as part of the solution. In work we at PPL have been doing recently, commissioned by the NHS Confederation and Local Trust, we have seen some fantastic examples of small investments by the statutory sector enabling local community groups to leverage really positive impact on the physical, mental and economic health of neighbourhoods.
We also need a mindset which sees that the upfront cost of doing all these things, and more, is an investment, not a drain on the nation. That is of course easy to say and extraordinarily difficult to achieve at a time when public finances are under huge pressure and the personal finances of many individuals make additional taxation understandably unpopular. But that pressure is, to an extent, the result of political choices, and governments, especially governments early in their term and carrying a substantial majority, are in a position to make choices.
PPL’s unofficial motto is ‘do what you can, with what you have, where you are’. That applies to individuals, to communities and to governments. And governments have bigger levers to pull. A government serious about improving the physical, mental, social and economic of its population will be a government serious about ensuring that in all its policies, it makes the big choices which create the conditions for individuals and communities to thrive. Let’s hope that when we get to the end of this new school year, the report card says ‘they did their best’, not ‘requires improvement’.
PPL is a management consultancy that specialises in tackling challenges in the UK’s health and social care sector.
Images: Helen Buckingham and Jordhan Madec
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