The health of the nation doesn't just rely on what the NHS does - it requires a wider view of our lives at home and work, and the public services that support them. John Copps argues that the whole public sector must learn from the insights of the recent Darzi review.
Last month Lord Darzi published his review of the NHS to much press fanfare. Commissioned by the new government immediately after it assumed office, its aim was to do a warts-and-all assessment of the state of healthcare provision in England.
The report makes bleak reading. Patient care is stagnating, and worsening in many cases, it says. Battered by underinvestment, multiple reorganisations and the Covid pandemic, demand has increased whilst quality and accessibility of care has suffered. 'Broken but not beaten' was how the Prime Minister summarised the message on the NHS.
Among the many causes of the NHS's woes, Lord Darzi points a finger at the wider determinants of health - among them poor quality housing, low income and insecure employment. The argument here is a simple one, but one that tends to be too often overlooked: our health is a function of many aspects of our lives, many out of range for the services that form part of the NHS.
If you are unemployed, you are more likely to be depressed. If you and your family live in a damp, mouldy house you are more likely to have respiratory problems. These experiences, and others, cause people to suffer and costs the NHS more money.
A healthy society is a successful society
On international and historical comparisons, a healthy country is a successful country. Why? Well, a healthy population means a healthy workforce. A healthy workforce is more productive, over a longer period of time, and spends less on services tackling the individual and societal impacts of worklessness.
As individuals, we all know health is an asset. It means we can be more active, enjoy ourselves more and work harder. It makes us more likely to be happier and earn more. As the World Health Organisation says 'health is wealth'.
Here in the UK, there is a dawning realisation how important health is to the functioning of the economy and the government's stated goal of economic growth. This is especially the case in the context of a tight labour market and a high proportion of the working-age population currently absent from the workforce due to sickness. The government has indicated that this is a nut they want to crack, with investment in healthcare interventions to help people back to the workplace. Mutual Ventures is supporting this through delivering the national 'WorkWell' programme, focusing on targeted interventions to help individuals remain, return or thrive in work in 15 pilot areas.
As a means to achieve economic growth, alongside its obvious impact on personal well-being, it follows that better health will benefit us all.
A whole government approach to health
The issues of poor health and fixing the NHS that Lord Darzi identifies need a system-wide solution. Better population health and better health services mean public services coming together to address the issues in people's lives.
The fact is that stresses across the system result in needs presenting themselves to the NHS. Housing, employment services, social care services, education, leisure services and the criminal justice system are drivers of health.
Of course, each of these public services has their own worries. I know that these are keenly felt from my own experience talking to social workers, probation officers, teachers and housing officers. But a siloed approach to services won't work any more. The success of the country and places relies on all these services working together.
Nationally, the new government's commitment to missions provides what could be the framework for implementing real cross-government change. At a local level, an example of an approach to knit public services together is Mutual Ventures' 'radical place leadership', which is about redesigning services around people and shifting power to communities. Radical place leadership relies on building a coherent narrative about a place, breaking down the barriers created through a service-led rather than person-led approach, and working with leaders right across the system. We are currently working in a number of places on this type of approach to bring about change.
The remit of Lord Darzi was to review rather than recommend. He picked out some themes to guide reform in the NHS, but I think the implications of his report must reach wider than it is to have a decisive effect. Looking seriously at joined-up action on the wider determinants of health - nationally and locally - is where we should start.
For more on the ideas raised in this article, and to learn how MV could help your organisation, contact john@mutualventures.co.uk.
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