We rightly focus on the day-to-day cash crisis afflicting the National Health Service (NHS), and the impact on patient care. In specific areas such as A&E, social care and mental health, there is real pressure on the system. But beyond these pressing concerns, we need an informed national debate about the future of health and social care in this country.
I am one of nearly 100 MPs from all parties who recently wrote to the Prime Minister calling for a convention to discuss a sustainable future for health and social care, anchored on the NHS principles that care is delivered based on need, not ability to pay. As successive studies and reports have made clear, from Beveridge to the Wanless Report, the most sustainable model is one based on a progressive system of taxation, with the broadest shoulders bearing the heaviest load, and also an effort, on all our parts, to control our own health and wellbeing.
As Derek Wanless’s report made clear a decade ago, for the NHS to survive the growing demands on it, we need more people to be able to live healthier lifestyles. Certainly, this comes down to personal responsibility for our diet, exercise, mental health, smoking, drinking and so on. But it also comes down to the choices that national and local governments make, and the environment we create for people to make healthy choices.
This is nothing new. Down the centuries, British governments have enacted laws designed to protect and improve people’s health, often in reaction to major health issues in society. In the eighteenth century, the government brought in restrictions on the manufacturer and sale of cheap gin. In the nineteen century, we saw the construction of the great sewers to tackle cholera and other water-borne diseases. In the 20th Century, governments passed the clean air acts, cleared the slums, vaccinated children and established the National Health Service. In the early twenty-first century, Labour brought in the smoking ban.
But new challenges arise in each generation. Today and tomorrow’s health challenges are the mental health crisis, the epidemic of loneliness, substance abuse, obesity, cancer, and the ways in which the tech revolution is impacting our physical and mental health. Hanging over each of these tough challenges is the shameful fact that poorer people suffer poorer health, and live shorter lives, than affluent people. The health gap between rich and poor is widening. In 2010, life expectancy for men in the most deprived parts of the UK was 9.1 years less than those in the richest areas. By 2015, the gap had risen to 9.2 years, with no signs of slowing down. There is a similar, widening gap for women.
And although life expectancy has broadly doubled since 1841 when the Victorians started to collect the figures, in recent years, for the first time in history, life expectancy has flat-lined. The BMJ reported that 10,000 more people died in the first seven weeks of 2018 than in 2017, with no obvious cause such as a flu outbreak. The Office of National Statistics has revised down its projections on life expectancy by a whole year, meaning they project a million extra early deaths over the next 40 years.
It is clear that we cannot simply carry on as we are, with business as usual. The scale of the challenge is too great. Our population is growing, getting older, and presenting more complex mental and physical health needs. The NHS will not survive to its 100th birthday unless we do something drastic. An answer to this crisis in social care, physical health, mental health, and health inequality is to introduce a new approach to policy-making across government which takes people’s health into account. This is sometimes dubbed a ‘health in all policies’ approach. What it means in practice is that national and local decision-making, policies and interventions would take place only after the full impact on people’s mental and physical health had been fully assessed.
For example, when we design our urban environments and build more homes, we need to build in opportunities for walking, running, cycling, swimming, gardening, sports and socialising, as well as community safety. When we imagine transport systems, we need to consider their impact on noise, the environment, journey times, and mental health, and opportunities for active travel. When we consider the vital first 1,001 days, from conception to age two, for a baby, we need to think about health, childcare, patterns of work and support for parents, the benefits system, and child-friendly spaces and services.
This requirement to consider mental and physical health would be enshrined in law by the Health Impacts (Public Sector Duty) Bill which I am introducing in Parliament through a Ten-Minute Rule next week. This would be the first systemic attempt to introduce health in all policies into the heart of governance. It would need to be driven by strong machinery at the heart of the government machine, and within local government. This could be a Cabinet sub-committee, comprising ministers across government departments, with the remit to block any policy decision which had not been properly assessed for its impact on our health. Or it could be a cross-department unit, based in the Cabinet Office or No.10, working across the boundaries of government department to ensure the health of the nation.
Most of all, though, it should be driven by a change of culture so that policy-makers and decision-takers put our mental and physical health first, whether it is deciding on building more homes, reforming the system of social security, designing the school curriculum or determining what goes into our food and drink. Our health is effected by virtually every aspect of central and local government policy, not just the Department of Health or even the NHS. We need to assess health in all policies, not just ‘health’ policies. This is the best way to tackle modern health challenges, to have an NHS for centuries to come, and to build a socially-just society.
Luciana Berger, President of the Labour Campaign for Mental Health and member of the Health and Social Care Select Committee