Labour’s health mission must be radical – and much wider than the NHS

Wes Streeting’s speech to the King’s Fund represented a thoughtful intervention on primary care. The makings of an energetic Labour programme for government that prioritises community-based services, boosts mental health support and creates a workforce fit for the future is emerging. The overall message of investment with reform is a sound formula. 

The Shadow Health Secretary recently teased that Keir Starmer will be setting out a “big Labour mission on health” in the next few weeks. It should be bold in analysis, scope and detail. The task is clear: to improve health in line with comparable countries and reduce health inequalities.

Accessible, high-quality and compassionate treatment and social care services are the foundation stone of a civilised society. Waiting times and strikes symbolise the symptoms of the ‘sticking-plaster politics‘ Starmer is rightly challenging. Herein lies Labour’s opportunity.

Labour must widen its policy lens beyond the NHS

Health policy and NHS policy are not the same thing. Labour has to widen its policy lens, complementing an NHS vision with a well-being agenda that creates health, drives economic growth and contributes to the goal of a more sustainable NHS and social care system. 

Here’s how. Whilst estimates vary, as much as 90% of our health is shaped by factors outside of health services. The ‘social determinants of health’ include income, education and employment opportunities and housing. This has to be understood, articulated and acted upon.

Recent research demonstrates the link between income and health. A University of Oxford and London School of Hygiene and Tropical Medicine study reported that while UK life expectancy has increased in absolute terms over recent decades, similar countries are experiencing larger increases. Income inequalities rose significantly in the UK during and after the 1980s, and that was accompanied by an increase in the variation in life expectancy between different social groups. 

As Nye Bevan remarked: “If freedom is to be saved and enlarged, poverty must be ended. There is no other solution.”

This is the moment to rebalance and reframe health policy. Starmer hit the nail on the head when he said he viewed “health as about more than hospitals and surgeries… It is about the towns and cities where we grow up, the food we eat, our access to green spaces” and promised to make well-being matter as much as economic output. 

This would mean sweeping renewal across health and care services and, crucially, the social determinants of health. A Labour government could reinstate the Child Poverty Act, commit to the Essentials Guarantee, sign up to all the recommendations in Javid Khan’s smoking review and reopen the hundreds of Sure Start centres closed since 2010. These policies would sit comfortably alongside pledges from Lisa Nandy to adopt a mantra of “council housing, council housing, council housing” and put into law a decent homes standard for the private rented sector. 

Health policy that looks beyond hospitals would be a voter winner

This is an electorally appealing pitch for a country aspiring to thrive not just survive. Fears of the nanny state are exaggerated. Indeed, it is often overbearing markets that seek to govern our choices, as companies spend millions on advertising campaigns driven by profit rather than public health motives (for every £5 we spend on public health, industry spends £200 on marketing unhealthy foods). Polling shows voters support action from the government to reduce harm from smoking and alcohol, restrict junk food advertising and tackle health inequalities.

Labour’s credibility will depend on the party outlining clear mechanisms for delivery, including who should do what. There is limited capacity and appetite for reorganising the health landscape, as integrated care systems, the Office for Health Improvement and Disparities and the UK Health Security Agency continue to bed in. There is though scope for changes to the wiring of Whitehall and to consider where health sits within the devolution framework set out by Gordon Brown. 

In the wake of the pandemic, now is the time for a reset

England would benefit from a version of the Well-being of Future Generations Act operating in Wales and requiring government departments and public bodies to consider the long-term health of people and planet when making decisions. A recent report from the IPPR called for a Health and Prosperity Act. To coin a phrase, those who prioritise economic growth over health deserve neither. A new cabinet committee for public health and even a Secretary of State for Public Health could provide essential political leadership. A sustained funding boost for local public health is also a must. 

Labour needs to embrace an ambitious plan to build back healthier, inside the walls of the NHS and beyond them. With the World Health Organisation declaring an end to Covid-19 as a public health emergency, now is the time to press reset in honour of the lost lives and the walking wounded. Focusing on the NHS may provide the route to power; however it is prevention that holds the key to sustaining it. Treating ill health and treating the causes of ill health would be a truly historic, unifying mission.