The UK has become the sick man of Europe – literally. On average, someone born in Germany, France, Sweden, Italy, Greece and Ireland (I could go on) will live longer than a person born in the UK. Political leaders need to change the record if we are to shift to a health and care service that focuses on keeping people healthy, not just treating the sick. Just last week, the Health Foundation published research that found that major illness is on the rise and by 2040 nearly one in five will have health conditions such as dementia and cancer, up from one in six in 2019.
“We know that with a relentless government focus on prevention, people could live healthier and happier lives, economic growth could improve, and there would be less pressure on the NHS” – so says the Labour Party’s health mission paper, published in May. This sentiment is supported across the health and social care sectors.
But after 20 years of politicians of all stripes repeating the same rhetoric it has not happened, and I’m sceptical about whether it will at all. The King’s Fund is currently considering what new thinking is required. At the top of my worry list is the fact that shifting the NHS from a “sickness service” to a “wellness service” lacks political popularity. Yes, Keir Starmer, the man expected to be the next prime minister, has said he wants an “NHS where prevention comes first”, but can he succeed where so many politicians have failed?
Previous attempts have been made to move to a more preventative healthcare system, including: Labour’s 2006 white paper “Our Health, Our Care, Our Say”; the coalition government’s 2014 NHS five-year forward view; and the Conservative government’s 2019 long-term plan. All were unsuccessful because respective governments prioritised more prominent items from their election manifestos.
Number one in the 2005 election was Labour’s 18-week waiting time target; 2015’s winner was the Conservatives’ seven-day-a-week NHS; and who can forget the 2019 promise of 50,000 more nurses and 6,000 more GPs. Politicians would argue they were giving people what they wanted, and prevention policies were always the underdog.
You might ask why it matters if prevention is not the top priority. Why can’t governments increase staff, reduce waits, and shift us towards a more preventative health service at the same time? Especially given there is public support for many public health interventions, such as restricting junk food advertising or introducing a “sugar tax” on soft drinks.
It’s because policymaking can be a zero-sum game. There are roughly 20 government departments, and they must all ask the Treasury and No 10 to provide the cash and political support needed for a policy. It’s not possible for everyone to get everything they want.
Look at the trade-offs made on funding and staffing as an example. In the 2000s the bulk of growth in the health budget went on the mission to improve waiting times, and in the 2010s public health and social care funding was cut to protect NHS budgets. Since 2010 the number of hospital-based doctors has continued to grow to try to meet demand, while the number of GPs, community-based nurses and health visitors has fallen.
Likewise on national oversight, prioritisation is required to avoid accusations of burdensome bureaucracy and too many targets. NHS leaders focus on balancing the books, Care Quality Commission (CQC) ratings, and waiting times, so it’s no surprise that only half of them say that prevention of ill health is a large part of their work.
But most people in UK now know that the health and care service is in crisis. Public satisfaction is at its lowest level on record and a third of staff are considering leaving the NHS. This suggests the electorate might be ready for some fresh thinking.
Prevention can rise up the political agenda with a clear vision, plan and mandate. Policies in this area need to be memorable tenets of “fixing the NHS”. Party leaders should build on existing public support and explain how these policies will help to get what they want from the health service. And this includes amplifying how living longer to see your children and grandchildren grow up is perhaps as important as reducing waiting times.
Politicians need to define precisely what they mean by “prevention” in their manifestos. It has become muddled with other phrases like, “care in the community”, “health inequalities”, “population health” and “wider determinants of health”. Members of the public need to know what they’re voting for: a minimum unit price for alcohol, more carers to help people in their homes, clean air regulations, a salt tax, or something else. And the next government will need to lead the diverse ensemble that is the NHS, the healthcare industry, national and local government, and others towards this prevention utopia.
So if prevention is best for our health, the NHS and the economy, then we all need politicians to make it more palatable. If, at the next election, politicians’ chorus of more money, more staff and shorter waiting times is coupled with tangible prevention policies, I’ll stop being a sceptic.