The proposals in Labour’s policy document are too vague – full of the right words but no clear strategies. This is a timid document that is shaped more by the financial constraints we face than by a courageous vision of health and care. The section on public health is relegated to the back pages and lacks any coherence or punch.
The document strongly endorses the WHO definition of health “as a state of complete physical, mental and social wellbeing and not merely the absence of disease”. While Labour’s plans for whole person care go some small way towards this, the document skirts round the nettle of privatisation. There cannot be fully integrated care while the private sector plays a significant role in the NHS. Privatising services leads to fragmentation and bureaucracy – imagine the difficulty in achieving pooled budgets whilst negotiating with several providers, many of whose aim is to make a profit out of health care.
As the paper recognises, even a publicly provided NHS at its best was not designed to fully achieve the WHO ideal of health. The Marmot Commission showed that 60% of a person’s health is determined by social and economic factors beyond the influence of the NHS. The people’s health is a nation’s greatest asset, but there is still a gap of 25 years in life expectancy between the richest and poorest areas of England, leading to shameful health inequalities. These factors must be addressed as a matter of priority. Unless we tackle inequalities in health we will never break the spiral of ever increasing expenditure on the NHS. To do this, future policy on health requires coordinated action across all areas of government policy and against the worst excesses of the tobacco, food and drinks industries. Labour should bring in the necessary legislation to reflect these requirements. This will underpin the strategy for health and care services in future.
Labour’s manifesto will be attacked by the media, who will demand costings for all its policy proposals. The legislation referred to above will not necessarily require a huge financial outlay. The sorts of actions the government could take that will have minimal financial consequences (at least initially) are:
- Create a new Secretary of State for Public Health (a cabinet post) accountable to Parliament and with powers to require government departments to act in the interests of public health (similar to the way the Treasury requires departments to act within budgets). This would be new post, separate from a Secretary of State for Health and Care, who would focus on delivering treatment and care.
- Strengthen the role of Directors of Public Health (or equivalent) at local, regional and national levels so that they can be independent and fearless in the advice they give and the actions they take.
- Require all government departments, arm’s length public bodies, local authorities etc to identify the health impacts of all policies and the actions they intend to take to deal with them, including an assessment of the impact on health inequalities
- For further actions see SHA ideas for public health policy
These actions should raise the profile of public health significantly and begin the shift of emphasis towards prevention. They should help to create a political climate whereby proposals for significant investment in housing, transport, education and environment and more (as laid out in SHA’s Towards a Policy Submission on Public Health by Tony Beddow) can be debated without the incessant chorus of “we can’t afford it”. The founding of the NHS was afforded in much grimmer financial circumstances because the nation was ready for it. It’s all about priorities and Labour’s strategy should aim to make Labour’s priorities the people’s priorities.