WWhen the secretary of state for health and social care, Wes Streeting, asked me to investigate the state of the NHS, I thought I knew what we would find. All of us who have worked in the NHS in recent years know that it was under pressure. But, as a surgeon, I am used to seeing only one piece of the puzzle. Hearing the experiences of millions of patients and staff across the country brought together left me shocked and angry.
If effective access and high quality care are at the heart of the NHS’s social contract with people, then it routinely breaks its promise to the public. Too many people are waiting in A&E corridors or struggling to see a GP. Quality care should be the organizing principle of the NHS. But my investigation has shown that patient care is stagnating or even declining. It’s no surprise that public trust in the NHS is at an all-time low.
Yet it is also clear to me that while the NHS is in critical condition, it can recover. Nothing I have found calls into question the principles of a health service that is funded by taxpayers and free at the point of need. We have some of the best clinical talent in the world, we are home to revolutionary medical innovation, and our staff is very passionate and committed.
Now the reality of what is happening in the NHS is out, we must start the recovery process. The time for looking back has passed. It is in that spirit that I published a second piece of work – the final report of the IPPR Commission on Health and Prosperity – which I have co-chaired with Dame Sally Davies, former chief medical officer, for the past three years. Last week I focused on diagnosis, but this final report turns to treatment.
In view of this, it may seem ironic that the focal point for this piece of work is not the health service at all – but almost everyone and everything else. This should not come as a surprise. While we may spend a few weeks or, if we are unlucky, months of our lives in hospital, we will spend years of our lives at work, school and in our communities. If we want to stem the rising tide of demand on our NHS, we need to look at what is happening beyond its hospitals and clinics.
This is the “pivot to prevention” that successive governments have talked about, but have not achieved. This new Labor government cannot afford to make the same mistakes. Here’s what Wes Streeting and Keir Starmer should do to make sure they don’t.
First, they should make healthy life expectancy a central focus of everything they do in government. Much as we have climate aspirations, such as net zero, I propose that we need a similar long-term intergovernmental health goal. Looking at what comparable countries have achieved suggests that an aspirational goal would be to increase healthy life expectancy by 10 years by 2055. With that goal established, we should then test government spending and investment decisions against their health impact in any fiscal event.
Second, the government needs to make health an inter-societal effort. The state that acts alone does not optimize our health. In particular, the government will need to get businesses and employers on board; they have a tremendous influence on our health. Sometimes this is positive – innovation in life science, good work or products that create health – and should be encouraged or scaled up. But sometimes it is harmful – alcohol, tobacco, insecure work and online harm – and this should be discouraged.
Let me be clear: if a business profits at the expense of our health, it must pay the social cost. The use of levies to enshrine the principle of “healthy polluter pays” acts as a powerful new incentive on the market, encouraging companies to prioritize healthier products. Where they resist change, the tax they pay would be a valuable new source of revenue, providing billions of pounds that could be invested in prevention.
Third, we should use the revenue from health taxes to invest in the foundations of good health. I think there is a special case to invest in the health of our children. I am alarmed by the health challenges facing children – the lower vaccination rates, the increasing number with severe asthma, a high number of children who are overweight or obese.
Tolerating this will put better long-term health out of reach. Sure Start and free school meals – the former one of the proudest legacies of the last Labor government, the latter being adopted by the Mayor of London – are both well-documented ways to boost children’s health.
Health is a human right. But as I pointed out in my review, and as the IPPR demonstrates today, it is also vital for a strong economy. With record numbers out of work due to illness, there is no path to well-being or growth without prioritizing health. It is a powerful platform for sustained and ambitious action by the new government.