We know that cardiovascular disease (CVD), including stroke, and respiratory disease are the world’s biggest killers, and they account for nearly a third of premature mortality in the UK. They are also major drivers of the gap in health outcomes between the richest and poorest in our society, responsible for around 40 per cent of the life expectancy gap between England’s most and least deprived areas. In 2018, cardiovascular disease was estimated to be responsible for the loss of over 21,000 “working years” in the UK.
But all is not lost – we have a huge opportunity to put things right for the health of so many of us if we can find better ways of preventing and treating these diseases. This would improve quality of life, create a more equal society, and ensure people are healthy enough to stay in work in their fifties and beyond.
This isn’t new. Politicians from all parties have, for decades, understood the huge potential inherent in tackling chronic disease – and there have been many attempts to galvanise the health service around this. The national service frameworks (NSFs) of the 2000s aimed to bring about long-standing improvements in performance on chronic diseases, including coronary heart disease. But while the approach was long-term and strategic – rooted in what we know works, and how to implement those interventions at scale – progress was disrupted by the structural reforms of 2010.
The NHS Long Term Plan, launched by Simon Stevens and Theresa May jointly in 2019, presented another progressive case for change that built on existing achievements. It set some ambitious goals for major chronic conditions without upending the entire system, and aimed to prevent 150,000 early deaths from CVD, stroke and dementia within ten years, alongside driving improvements to respiratory care. Despite this good work, diagnosis and treatment across major conditions are still not reaching the standards they should. Greater focus and ambition are needed to ensure patients get the care they deserve.
Major announcements and plans for population health, like the NSFs and the Long Term Plan, are welcome, but these are just the blueprint. The NHS is too large, sprawling and varied an institution for policymakers to set targets and simply assume these will be implemented. Much of the work needed is around setting the right conditions and expectations for change at the local and regional level, where interventions can be really effective and meet the needs of the local population and context. Incentives like the Quality and Outcomes Framework for general practice and having the right organisational structures in place, from primary care networks to integrated care systems, will drive better performance at scale. We’ve seen disease-specific clinical networks play a role in sharing practice that improves care across regional footprints, but they can only work when fully funded and supported by the centre.
The Covid-19 pandemic has, of course, disrupted progress towards Long Term Plan targets. Discussion of a Long Term Plan “reset” has also surfaced at numerous points over the last couple of years. Mounting numbers of families are facing an agonising wait for care – the health service is struggling with backlogs and waiting lists for diagnostic tests and elective treatments, and new waves of Covid-19 combined with infections like flu and respiratory viruses (such as RSV) are set to put enormous pressure on hospitals again this winter.
Furthermore, delays to care for people with long-term conditions during the pandemic are likely to have long-term effects on them and their families, with large numbers of people having missed out on standard diagnostics, such as spirometry, or treatment options, like rehabilitation, which will set back their health. These are all challenges that the next government will need to grapple with.
Now, however, there are some signs of progress picking up again – in increased numbers of health checks, for example – and we must actively support this progress and resist the temptation to reach for radical top-down, disruptive change. The government’s Major Conditions Strategy, due for release early next year, will look at accelerating necessary improvements in the prevention and diagnosis of the six biggest killers, including respiratory and cardiovascular disease and stroke. This is set to build on, but not replace, the Long Term Plan.
In preparing its plans for the next general election and beyond, Labour has an opportunity to lay out its ambitions for our nation’s health. The party has rightly stated that it wants to focus on the biggest preventable causes of death, but the diseases that our charities fight also cause millions of people to live in poor health for years or decades of their lives. These are our parents, grandparents, children and siblings. Labour has also been clear it will prioritise public and population health through tackling entrenched problems like smoking, obesity and lack of physical activity.
But, Labour must also grasp that starting with a blank sheet of paper may not be the best way. Preserving what is working well, protecting the tentative progress that is already happening, setting new policies to address the gaps, taking a new approach to the common environmental drivers, such as smoking and obesity, and recognising that these are largely not in the power of the health service to solve – these are the steps that will give a Labour government its best chance of getting the UK back to health.