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We must spend more to create a healthier society

David Taylor-Gooby

NOT long ago Rishi Sunak made five promises. He would halve inflation, grow the economy, reduce debt, stop the small boats crossing the channel and reduce NHS waiting lists.

He may well succeed in the short term with the first three, but at the cost of the worst-off in society bearing the biggest burdens.

He doesn’t look as if he is getting very far with the fourth at the moment. But what about the last one?

I have always supported the NHS. I feel that it is a practical example of socialism that works.

We all contribute, and we all use it when we need to.

Many Conservatives don’t like it for that reason. But years of underfunding have led to real dangers to the service.

We see more and more advertisements for private consultations and visiting GPs.

The Government will not dare to say they want to run down the NHS – that would be very unpopular, but they may hope that this steady drip, drip, of people going private when they can means it becomes a service for the poor, and will get even worse.

If a large chunk of the population no longer use it, that will justify funding cuts. That will help with the top three targets of course. Rewind to 2007.

The NHS was in a similar mess. Tony Blair is criticised for many things. But he did increase funding for the NHS.

We were only spending 6% of GDP on it, compared with a European average of 9%.

There was a 50% increase in spending over five years, the waiting lists vanished and the private sector drastically declined.

Then the Tories won the election with a promise to cut public spending and we know what happened next. Budgets were cut.

We had the largely unsuccessful efforts to introduce private services and competition into the NHS with the 2012 Act which introduced commissioning and compulsory tendering. Six years later Theresa May admitted it had been wrong and we now have a more cooperative model.

But funding is now far too low and that is why the service faces collapse. Will Rishi Sunak face that problem?

A less well-known achievement of Tony Blair’s government was a substantial increase in funding for public health.

It is accepted by most of those who study our system that more spending on preventing bad health (which is what public health does) substantially reduces the burdens on the health system, which is mainly about looking after people and treating them when they are sick.

The Blair government integrated public health (which had previously been part of local government) into the rest of the health system by setting up local primary care trusts.

These lasted from 2001 to 2011. They spent 80% of the NHS budget.

Much of that was paying for hospital services, but a substantial amount was kept for services in the community to look after those who needed care at home and to promote good health.

Were they a success? From my experience I would say yes. My wife and I were both involved in the NHS in our area, east Durham, as lay members, and I was involved in the system that followed, so we had some direct experience of what happened.

East Durham has traditionally had bad health, partly as a legacy of mining and for a long-time health was chronically underfunded.

Local politicians in the area agitated for more funding and in the end we got it.

The PCT spent much of that extra money on promoting good health and on engaging with the public.

An example of the improvement in public health was reducing smoking. A joint campaign with other PCTs in the North East reduced smoking by 30% amongst adults between 2005 and 2013. Schemes to promote exercise were established, and there were healthy eating projects including setting up new allotments.

The Easington PCT also spent a considerable amount on public engagement. Critics said this money should go to funding hospitals, but I do not agree.

Efforts to improve public health mean improving diet, reducing alcoholic drinking and encouraging exercise.

Of course, food and drink manufacturers will lobby against this. But criticism will also come from the right-wing press, with accusations of ‘nanny state’ and being a ‘kill joy.’

Boris Johnson, hardly a paragon of good health, was quick to do this. But it is true that you cannot force people to be healthy by diktat.

Improving health and encouraging healthy habits has to be done by persuasion, not orders.

That is where public engagement comes in. The Easington PCT had a very successful programme which reached a large number of people.

After 2012 when public health returned to local government, budgets were cut and much of this was abandoned. But their achievements persisted.

A recent article in the Economist Magazine, hardly a left-wing publication, argued that 40% of the burden on the NHS may be preventable through tackling the causes of avoidable conditions.

But in 2020 less than 7% of overall healthcare spending went on prevention. People are dying who do not need to.

The immediate task the Government faces is stopping the collapse of the NHS.

But, longer term, if we want a healthier society much more must be spent on preventing illness through community-based public health.

Efforts to improve public health mean improving diet, reducing alcoholic drinking and encouraging exercise

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2023-03-20T07:00:00.0000000Z

2023-03-20T07:00:00.0000000Z

https://thejournal.pressreader.com/article/281861532743759

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