The publication of Labour’s ‘Health Mission’ was the first time in a long time that we heard anyone describe their ambition for health and health services in the round. The inexcusable absence of a current and coherent workforce plan, plans for social care, or public health means we have got terribly used to piecemeal announcements that make headlines for a few days, but won’t shift the underlying drivers of unprecedented health and care pressures.
Given the terrifying state both the NHS and social care are now in, with no visible ambition on the part of people in charge to substantially intervene even before the next winter crisis hits, it seems plausible to ‘focus on the basics’. This is not the time to announce shiny initiatives – people understand that services need to be repaired before they can be polished, and the exhausted health and care workforce will just shrug their shoulders at fanciful announcements.
Given that ‘the basics’ tend to be understood largely as access rights; to primary care, secondary care, emergency services, the promise to reinstate the targets set by previous Labour Governments is therefore unsurprising – but nevertheless very ambitious. Last time those were achieved, it took ten years to get there, and significant above inflation investment.
However, more interestingly, the mission document also sketches out a vision for health, rather than illness services. This is welcome, and long overdue. It is good to see mention of some childhood obesity ambitions, but if we want to move the dial on the ever-growing burdens of preventable ill health in this country, we will need to do much more than that. So it is good to see a commitment to health in all policies.
Quite apart from the obvious problem that both improving access, and creating better health through better planning, work, housing and places will cost money, another tension will arise. When being told to increase hospital activity, but at the same time improve people’s health through upstream investment (into community connection, social prescribing, rehab, supported self management and plenty other ‘out of hospital’ interventions), the health and care system tends to only hear the first part of this message. This is largely because of how the money flows and the outcomes are reported back to the centre.
We have had decades of policy papers and NHS plans proclaiming that care needed to be moved out of hospitals, closer to communities, become more proactive and preventative, work with people and communities better, and so on. And on all those indicators things have got worse: a smaller proportion of investment has gone into care outside of hospitals, it is nigh impossible to find, let alone access, any kind of preventative services now, be that in the shape of community based mental health support, speech and language therapy or social care.
It is hard to see how Labour’s plan will turn this around in one Parliament – fixing access to specialist care alone will take a huge amount of headspace and investment, so there is a substantial risk that statements on a bold ambition for a healthier Britain will just remain warm words. I see some cause for optimism though:
· The wider arguments about giving control back to people and communities, made by Labour through other mission statements, and also quietly resonating through the Health Mission make it clear that it understands that the old ‘command and control’ style way of trying to run the Government and its services is a part of the problem.
· Further, the only new targets set out in the paper are actual ‘outcome’ targets. So they don’t say ‘you will be seen within a fortnight’, but ‘we will reduce deaths from stroke, heart disease and suicide’. If you want to improve these actual outcomes, you have to move away from focus on specialist hospital activity. Somewhere in the mix, access to a hospital doctor will make a difference to these real-life outcomes, but mostly, they are about better primary care, finding people at risk and supporting them to engage with treatments, but crucially also the stuff we consider ‘non clinical’: good work, good places, good community connections. This is what changes people’s behaviours, and importantly gives them hope and a reason to try to stay well.
Bringing both progressive ideas together – community power, and a stronger focus on outcomes, might just be the magic ingredient that will make a difference between this plan, and the numerous previous papers published by the NHS and governments declaring the need to invest in better health, rather than just sickness services. It would be useful to figure out over the next 12 – 18 months how communities could be brought into both the design and delivery of collaborations and partnerships that will create health, rather than undermine it. It would also be progressive to think through how people and communities could be part of an accountability framework that ensured local partnerships between the NHS, councils, house builders, employers and voluntary organisations actually deliver better health for people.
Health by and for the people. That’s a mission to get out of bed for.
If you enjoyed this blog, check out another analysis of Labour’s health mission in ‘Healthy Homes: Labour’s Five National Missions Should Recognise the Connection Between Growth, Homes, and Health’ by Cllr Promise Knight.