Lord Bethell was Minister for Innovation at the Department of Health and Social Care during the pandemic.
Britain has become the ‘sick man of Europe’. No one likes to admit it and we all fear the medicine necessary to fix it. But the electorate craves answers, and evidence shows voters will support hard choices. There is a rich political dividend for whoever can offer the vision of making Britain the healthiest country in the world.
The problem is stark. Last week, new research by the IPPR Commission on Health and Prosperity – in which I’m a commissioner – showed that the UK had 240,000 more avoidable deaths in the decade from 2010 than if they had matched outcomes in European countries. That’s all before any of us had ever heard of Covid.
I regard these avoidable deaths as a moral outrage. But even if you are more sanguine, we can all recognise it is an economically illiterate way to run a country. The OBR, Bank of England, and IMF increasingly recognise that the rising tide of sickness is set to bankrupt the Treasury, not least as economic inactivity due to sickness reaches new records and curtails growth.
We cannot afford this financial and social price. Voters see that something has got to give. But I am worried that our current cohort of leaders does not realise just how big a change in mindset is needed to deliver Healthy Britain.
Our policy makers, politicians and, I am afraid, many of our doctors have fallen into the trap of thinking that more of the same is the answer – more expensive doctors, bigger hospitals, shinier machines-that-go-bing, more money for the same old services. The Prime Minister, who was brought up in the NHS, made the pitch very clearly: “more resources, more staff, more choice”.
I agree that we should spend a larger proportion of our GDP on health, that there is a troubling infrastructure investment deficit, and that we need to accelerate the adoption of new technologies and treatments. But the hard truth is that there’s not much “more hospitals” and “more doctors” can do about the biggest threat we face today: chronic health conditions caused by the decisions we make and the environments where we live.
Consultants and hospitals are a good answer when most health needs are short in duration, deadly, and demand an emergency response – “lumps and bumps”. But they have not helped so much with health conditions that last years and need on-going support and care like diabetes, dodgy tickers, and dementia. And it is an expensive, ineffective approach if that’s the only string to your bow.
Simply doubling down on an outdated model of healthcare – say, by doubling the size of the clinical workforce in a decade as envisaged in the new NHS workforce plan – is an over-simplistic answer. We need to change direction, to pivot towards a prevention agenda.
Everyone agrees on this principle. Pivoting to prevention is written in the NHS Plan. But we are being held back by vested interests, institutional torpor, and cultural resistance to change. Our efforts to change our health system from the acute health needs of the 1940s to the new epidemiological and demographic realities of the 21st century are woefully slow, unambitious, and uncreative. That’s why our health outcomes are behind other countries, and recruiting doctors and building hospitals will not improve things unless we change this mindset.
Creating a healthy Britain means bold efforts for the whole of government and society to focus on the things we can change before we’re sick. Yes, people need to take responsibility for their decisions. But decisions do not take place in isolation: the Government needs to pitch in.
The Government needs to resist the clamour from ideological libertarians and give people the tools they need to lead healthy lives and address the culture of the nation towards food, activity, and looking after yourself, as they do in other healthier countries.
As titans of our party like Benjamin Disraeli recognised, when he said “the health of the people is really the foundation upon which all…their powers as a state depend”, it is highly un-Conservative to not first give people the means to take responsibility.
If we want to take pressure off the NHS while strengthening our economy, we need a government willing to pitch in on dirty air, workplace health, mouldy homes, junk food, and tackling addiction. Their mantra should be “Make the healthy choice the easy choice”.
Vested interests can lobby with their misinformation and libertarians may parade their ideological scepticism, but there is now excellent evidence on what policy interventions work effectively. Salt and sugar levies drive the reformulation of food: just look at the success of the Sugary Drinks Tax.
Enforcing housing standards can get dampness and mould out of rented homes. New Zealand’s gradual ban on smoking will deliver a truly smoke-free generation. ULEZ clearly reduces particulates that cause asthma and reduces pressure on hospitals that are swamped with patients with respiratory conditions.
Alongside that, we should evolve the NHS’ role. I have three suggestions to begin to move it into the 21st century:
Here’s the good news. If our politicians and clinical leadership get this right, they will save lives. They will get hundreds of thousands of workers back into work, adding tens of billions to GDP. They’d raise significant tax revenue, without raising taxes.
But more than that, they’d avert a current inevitability where the NHS delivers below-average outcomes at extortionate cost and blows up the public finances so we cannot afford to educate or defend our country. Modeling shows that getting prevention and productivity right in the NHS will save £200 billion over the next decade, compared to our current trajectory. Imagine what that sum could do if it were instead invested in public health?
Healthy Britain is the mission for government that affects us all, and that we all have a role in. The public, businesses, and charities are up for it. Now it’s time for ministers and clinicians to get behind the new model of health policy this country desperately needs. They would find strong support from voters.