When the secretary of state for health and social care, Wes Streeting, asked me to investigate the state of the NHS, I thought I knew what we would find. All of us who have worked in the NHS in recent years have known it was under pressure. But, as a surgeon, I am used to seeing just one piece of the puzzle. Hearing the experiences of millions of patients and staff across the country brought together left me shocked and angry.
If effective access and high-quality care are at the heart of the NHS’s social contract with the people, then it is routinely breaking its promise to the public. Too many people are waiting in A&E corridors or struggling to see a GP. Quality care should be the organising principle of the NHS. But my investigation has shown that patient care is stagnating or even declining. It is unsurprising that public trust in the NHS is at an all-time low.
And yet it is also clear to me that while the NHS is in critical condition, it can recover. Nothing I found drew into question the principles of a health service that is taxpayer-funded and free at the point of need. We have some of the best clinical talent in the world, we are home to groundbreaking medical innovation, and our staff are deeply passionate and committed.
Now the reality of what is happening inside the NHS is out there, we must begin the process of recovery. The time for looking backwards has passed. It is in that spirit that I have released a second piece of work – the final report of the IPPR Commission on Health and Prosperity – which I have co-chaired with Dame Sally Davies, former chief medical officer, for the past three years. Last week I focused on the diagnosis, but this final report turns to treatment.
Given this, it may seem ironic that the focal point for this piece of work is not the health service at all – but almost everyone and everything else. This should not come as a surprise. While we might spend a few weeks or, if we are unlucky, months of our lives in hospital, we’ll spend years of our life in work, school and in our communities. If we want to stem the rising tide of demand on our NHS, we need to look at what is happening beyond its hospitals and clinics.
This is the “pivot to prevention” that successive governments have talked about but failed to deliver on. This new Labour government cannot afford to make the same mistakes. Here is what Wes Streeting and Keir Starmer should do to ensure they don’t.
First, they should make healthy life expectancy a central focus of everything they do in government. Much like we have aspirational targets on climate, such as net zero, I propose we need a similar long-term, cross-government health target. Looking at what comparable countries have achieved suggests an aspirational goal would be to increase healthy life expectancy by 10 years by 2055. With that target established, we should then test government spending and investment decisions against their health impact at every fiscal event.
Second, the government needs to make health a cross-society endeavour. The state acting alone will not optimise our health. In particular, government will need to get businesses and employers on board; they have tremendous influence over our health. Sometimes this is positive – life-science innovation, good employment or health-creating products – and should be incentivised or scaled. But sometimes it is harmful – alcohol, tobacco, insecure work and online harms – and this should be discouraged.
Let me be clear: if a business profits at the expense of our health, it should pay the societal cost. Using levies to enshrine a “health polluter pays” principle would act as a powerful new incentive on the market, encouraging businesses to prioritise healthier products. Where they resist change, the tax they pay would be a valuable new source of revenue, providing billions of pounds that could be invested in prevention.
Third, we should use the revenue from health levies to invest in the foundations of good health. I think there is a particular case to invest in the health of our children. I am alarmed by the health challenges facing children – lower vaccination rates, rising numbers with severe asthma, high numbers of children who are overweight or obese.
Tolerating this would put long-term better health out of reach. Sure Start and free school meals – the former one of the proudest legacies of the last Labour government, the latter having been adopted by the mayor of London – are both well-evidenced ways to boost children’s health.
Health is a human right. But as I pointed out in my review, and as the IPPR demonstrates today, it is also vital to a strong economy. With record numbers out of work because of sickness, there is no path to either wellbeing or growth without prioritising health. That is a powerful platform for sustained, ambitious action by the new government.
