Widening the view

Blair’s narrow focus on the NHS means this government could be deprived of a
more rounded, long-term view of other measures that also promote health and
well-being, argues Anna Coote.

much does the government care about health and social care? No one could doubt
its commitment to the NHS. Only recently, when the Prime Minister was asked by
a Labour backbencher in the House of Commons to give "a brief
characterisation of the political philosophy that he espouses and which
underlies his policies" he replied that the best example he could give was
"the rebuilding of the National Health Service".

Backing a public service rather than an idea
or belief system may be an honest option in these non-ideological times.
Certainly Blair has been true to his "philosophy" – pouring yet more
Treasury cash into the NHS in last month’s budget. But the vision is a narrow
one. It is precisely the "national health service" that is Blair’s
icon. Not the health and social care system.

Did the Prime Minister say he wanted to be
judged on how far he managed to improve care for the elderly, the disabled and
the chronically ill? What is his political philosophy on that? Social care
remains the poor cousin who must be content with scraps from the table. The
scraps are more generous now, because failings in the social care system must
not be allowed to impede progress on NHS waiting times. But scraps they remain.

The narrow focus on health services means
there are no real incentives to think in a rounded way about how these vast
resources are best deployed. The NHS is not just a provider of services. It is
a huge institution. It is the largest single employer in the country with more
than a million staff. If you take contract workers into account, it employs in
London alone more than 7,000 people for every borough. It spends £11 billion on
goods and services every year. It is the largest single purchaser of food in
the country, spending some £500m on 300 million meals for patients, staff and
visitors. It generates a huge amount of waste – more than 600,000 tonnes a year
– and spends £42 million a year disposing of it. It is a major cause of travel,
consumer of energy and constructor of new buildings.

Yet very little thought has so far been given
to how to realise the full potential of this extraordinary purchasing power.
How can it help to achieve the underlying purpose of the organisation, which is
surely to safeguard and improve the nation’s health, not just provide services
to those who are ill?

Take employment, for example. The NHS is
desperate to recruit staff. It wants to achieve a net gain of 35,000 nurses,
midwives and health visitors by 2008. Yet 110,000 nurses who are in service are
due to retire by 2004. The challenge is enormous. It is busily recruiting
nurses from abroad. Yet many hospitals are sited in areas of high unemployment,
and unemployment is known to be bad for health. Local residents are not
qualified for nursing jobs or don’t come forward for training. And when the
poverty and powerlessness associated with unemployment damage their health,
they end up as NHS patients rather than staff. What kind of political
philosophy allows that to happen?

The Department of Health is beginning to
consider a step-by-step recruitment process that develops people’s basic skills
and enables them to move up the ladder into health-related jobs, or stop off
with appropriate qualifications at any stage. But this is a long way from
becoming routine practice across the NHS.

The same logic can be applied to decisions
about purchasing goods and services. Can the NHS work with local businesses to
develop their capacity to supply what the NHS needs – and so strengthen and
support the economies of disadvantaged communities? And what about
commissioning new buildings? Can the NHS ensure they are designed to enhance
the health of patients and staff? That they are located to discourage road
traffic? That they are built with materials from renewable sources and, where
possible, by local workers?

To do all this would require a rounded, long-term
view of the relationships between health, employment and health services, and a
commitment to invest in measures that would promote health and sustainable
development over time. That really would reflect a political philosophy worth
the name.

Anna Coote is director of public health, The
King’s Fund.

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