“The old normal was bad for people’s health”: Ex-NHS chief calls for a healthcare New Deal

Nigel Crisp on how the country should change its attitude towards health as well as healthcare during the coronavirus pandemic recovery.

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The NHS has been fighting for our lives for the past few months, throwing all its resources at the pandemic. Millions of health and care workers have been magnificent, rising to the occasion with bravery and skill. They have demonstrated, among other things, that we must support and resource them better for the future.

And that future will undoubtedly be very difficult. The virus will leave behind enormous mental and physical health problems. Some will be due to the trauma of the deaths and the difficult working environment, some the result of isolation, some from increased stress and domestic violence in the cramped spaces of lockdown, and some because of delays in other treatments. There will also be health consequences from the economic collapse with more people unemployed and in poverty. And social care will need major investment and reform.

The government has also had a crucial role to play in the pandemic: providing leadership and direction, introducing emergency legislation, and supporting the NHS and the economy. It will face tough questioning about its preparedness and performance, and about why the UK death toll is so high. And there are immediate lessons to learn about planning for a possible second wave and how to increase UK resilience.

There are longer-term questions, too, about the government’s vision for the future, how it will reshape the economy and workforce, and how it sees the UK’s position in the world.

Civil society has also played its part in tackling the pandemic. It’s been up to us, the general public, to help mitigate how far and how fast the virus spreads. Our behaviour has mattered. And millions have volunteered to help, kept community and voluntary activity going, or simply looked after our neighbours.

Millions more have kept the vital non-health emergency and other services running in agriculture, retail, delivery, power, transport, finance, rubbish collection and so much more. We have all had our part to play.

The pandemic has shown us clearly the different roles played in health by the NHS, government and civil society. All are needed and all are facing profound changes. Three areas stand out: technology, people and creating health.

The most obvious is the growing importance of technology. Virtual consultations have gone from less than 2 per cent of all clinical consultations pre-pandemic to more than 80 per cent during. Testing and tracking systems, life support equipment, vaccines, and new therapies are all vital for the future. And the combination of a health and financial crisis will drive innovation in all aspects of health technology.

Health and care are ultimately about people and relationships. The shortages of personal protective equipment, and deaths among health and care staff have been shocking. But the response has been impressive. Front-line workers have told me about improved team working, quick decisions and focused action. People have been motivated by their passion and commitment, not incentivised by reward.

The professionalism of nurses for example – who are too often undervalued – has been visible in every area, from the community to the most intensive hospital treatment. The public has clearly noticed, and applications for nurse training have increased.

Any Roosevelt-style New Deal to tackle the economic crisis must surely involve investing in new jobs in health and the long-neglected care system. And it will help the economy: a healthy population is productive and inventive.

There needs to be a new emphasis on creating the conditions for people to be healthy and helping them to be so. Not just preventing disease but creating health.

The pandemic has reminded us of some of the uncomfortable truths about our society. The migrant workers who do so many of the lowest-paid and insecure jobs, the millions on zero-hours contracts with no support, the poverty and inequality, and the way different ethnic groups have been affected. The old normal was bad for very many people. And it was bad for their health.

The NHS can’t tackle these issues. And the reality is that the NHS can’t deal by itself with many of today’s major health problems such as loneliness, stress, obesity, poverty and addictions. It can only really react, doing the repairs but not addressing the underlying causes.

Government policy is vital but it can only take us so far. Employers, teachers, community leaders, families and architects all have a responsibility and a role to play. And there are people all over the country who are tackling these causes in their homes, workplaces and communities. The leaders and pioneers. People like the Berkshire teachers working with children excluded from school, the unemployed men in Salford improving their community, the bankers tackling mental health in the City, the housing associations supporting their tenants and many others.

There is a Ugandan saying: “Health is made at home, hospitals are for repairs.” It is also made in workplaces, schools, communities and wider society. Everyone and every sector have a role to play.

And the NHS and the government need to work with civil society and these pioneers to build a healthy and health-creating society.

Nigel Crisp is a crossbench member of the House of Lords. He was chief executive of the NHS in England and Permanent Secretary of the UK Department of Health from 2000-06. His new book “Health is made at home, hospitals are for repairs” will be published by SALUS Global Knowledge Exchange on 29 June.

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