The Elephant in the Room
It’s pretty clear that the NHS is at the top of most voters’ priorities, with big concerns about access to GPs, lengthy waiting lists, and a sense that it has been starved of funds and resources. To add to the NHS’s problems, the country has very poor levels of health with an ageing population, both of which are big drivers of demand. Little wonder it is sometimes described as a national sickness rather than a health service.
This approach has much wider economic and social impacts, not least in the number of people unable to work because of health issues. Many different factors cause ill health and most lie outside the NHS itself. Diet, exercise, housing and poverty are just a few examples. The reports by Sir Michael Marmot go into the detail. This makes ill health a particular challenge to tackle, but unless we tackle it, demand on the NHS will grow unmanageably along with the costs.
Chairing this session is Norman Lamb, who was a LibDem MP and a health minister. He now chairs the South London and Maudsley NHS Trust and co-chairs the Health Devolution Commission.
Bringing a perspective from inside the NHS, Wendy Taylor was an oncology consultant. She is also a LibDem councilor in Newcastle City and is currently the chair of the Health and Social Care Committee.
Roy Lilley and Ed Smith are collaborating on a book about the subject, which they refer to as the ‘elephant in the room’, and last year published 200 Questions for the Future of the NHS. Roy is a health policy analyst, writer, broadcaster and commentator on NHS. He has been the vice chairman of a health authority and chair of an NHS trust, and has taught at both Imperial College and Nottingham University. Ed Smith was the chair of NHS Improvement, and deputy chair of NHS England. He now supports a number of health organisations along with other advisory roles in the UK health economy.
Synopsis and analysis
This discussion is looking at the drivers of ill health and how they can be tackled. In particular we look at the politics and organisational aspects and the importance of much more local and collaborative approaches.
The starting point is a frank assessment of the health of the UK population. Why is it that we have one of the unhealthiest populations amongst developed countries? What might that mean in terms of demand and costs in the NHS, apart from all the wider social and economic consequences? It’s not as if this is news, as it has been covered in detail previously, notably by Sir Michael Marmot with his reports going back to 2010, and others before that. Is it just about more money and resources for the NHS or are we missing something in how and where we tackle the problems?
The panelists bring first hand experience: Norman Lamb as a health minister and now chair of a health trust; Wendy Taylor as a clinical oncologist and a local councillor; and Roy Lilley and Ed Smith with business backgrounds but having led and worked extensively with health trusts and both public and private health bodies. All are strong supporters of the NHS, but recognise the difficulty of dealing with the ever-escalating demands of an unhealthy population.
Marmot came up with the phrase ‘the freedom to live a good life’, which seemed a good liberal way to summarise what we are aiming for. The problems he identified included poor housing, poverty and inequality, decent jobs, education, diet and exercise, all of which the panel agreed with. There was strong agreement that most of this primarily needs to be tackled locally, engaging with local communities to tackle local needs. There is an important role for public health – savagely cut under the Conservatives – working alongside local government, businesses and voluntary organisations, which in turn means more collaborative leadership. This has already been shown to work with successful programmes in different parts of the country.
For central government, this will need much more power and resources to be put back into local government, with the introduction of local taxes as an option. In the discussion the group also challenged the idea of the ‘nanny state’ head on. Surveys show that the public is highly supportive of legislation in areas such as food standards, just as they have been for seat belts, reduced sugar in drinks and smoking bans.
Altogether, this is a critical area if we are to tackle both ill health and a struggling NHS, with economic implications – an unhealthy society does not make for a healthy economy. For the LibDems, there is scope for a new narrative that takes on this challenge. Could this be part of an ‘Age of Renewal’ as the panel suggested?
Interested in learning more? A few suggestions include::
The Last Marmot Report on UK health: https://www.instituteofhealthequity.org/resources-reports/fair-society-healthy-lives-the-marmot-review
Roy Lilley and Ed Smith’s book, 200 Questions for the NHS: https://fabnhsstuff.net/fab-stuff/200-questions-for-the-future-of-the-nhs-and-the-elephant-in-the-room
You can listen to the podcast here: