Health

Lord Crisp Excerpts

Thursday 26th November 2015 Lords Chamber

Moved by

[Lord Crisp]

To move that this House takes note of the case for building a health-creating society in the United Kingdom where all sectors contribute to creating a healthy and resilient population.

[Lord Crisp (CB)]

My Lords, first, I thank my noble friends on the Cross Benches for choosing this debate today, but I also thank all noble Lords who are taking part in it. I am very much looking forward to hearing everybody’s contributions. I recognise that this is last business on a Thursday, so I am particularly grateful to noble Lords taking part. I also welcome the three noble Lords making their maiden speeches. I know that we are very much looking forward to what they have to say now and in many future contributions in your Lordships House.

The health and care system is under great strain as needs grow, particularly from older people with long-term conditions, and as costs rise. This mirrors the position elsewhere, not only in Europe and America but in many fast-developing countries. Not surprisingly, and not just in the UK, there is widespread concern and considerable confusion about the future for health. This uncertainty and insecurity means that it is more important than ever to understand the complex nature of health problems and what can be done about them, and to set out a long-term vision and strategy for the future.

Health and well-being are affected by three big things: the availability and quality of health and care services; individual lifestyles and behaviours—individual responsibility for our own health is absolutely vital; and all the physical, economic and social factors such as education, employment, wealth, social structures and the physical environment. Those are the many determinants of health, and co-ordinated action is need across all three areas. However, my focus today is on the third of these—the wider determinants of health, which go way beyond the reach of the NHS and individuals.

There is a great World Health Organization quotation:

“Modern societies actively market unhealthy life styles”.

I want to talk about how we can set that on its head. What would it be like, instead, to build a health-creating society where everyone—citizens, families, communities and businesses alike—had a role to play? None of what I have said, however, should detract from the importance of the first two—the health and care system, and the choices and actions of individuals—and I am sure other noble Lords will address those.

Let me just give a few examples of what I am talking about. Barely half of our children achieve a good level of development by the time they start school, which affects their future physical and mental health and, of course, their ability to learn. Going to the other end of the age range, social isolation and loneliness in old age have the equivalent health impact of smoking 15 cigarettes a day and a slow recovery from illness. There is recent evidence that they also lead to earlier death. Having a social network and some meaning in life is hugely beneficial. Some groups in the population are affected more than others, including people with mental health problems. Men with severe mental health problems die up to 20 years earlier, and women 15 years earlier, than people without such problems. Importantly, there are also lower levels of subjective well-being and a higher burden of ill health in people from black and minority ethnic communities. Moreover, as Sir Michael Marmot has demonstrated, inequality damages health, with the most disadvantaged being most prone to ill health and living shorter lives.

Perhaps the most alarming statistic of all is that, on average, UK citizens have about seven years of ill health before we die; at the top of the scale, the Norwegians have only two years. What if we could reduce the UK figure by even one year? What a difference that would make for individuals and, at the same time, for the health and care system and therefore the economy. What is so different about Norway? This surely gives us a target to aim at.

These are complex problems, and they illustrate clearly that health cannot simply be left to individuals, the NHS, professionals or government. Everyone in every sector has a role to play. Moreover, improvements in health go hand in hand with improvements elsewhere. Education, the environment and the economy: all will benefit from a health-creating society. Better health and greater prosperity go together.

This is also very relevant to the future sustainability of the NHS, which is often discussed, like so much in health, in largely economic terms, as if it were really an economic problem and there could be purely economic solutions concerned with financing and/or restricting services and treatments. However, experience from the Netherlands to the USA shows that those solutions produce at best limited gains and may increase the economic cost to society as well as individuals. The long-term sustainability of the health and care system will come from changes in practice, finding health solutions to health problems and moving upstream into prevention, health promotion and, as I suggest here, building a health-creating society. Arguably, the NHS will not be sustainable without this.

Those are the problems, but an enormous amount is already being done. We can look at what is going on in the community and voluntary sector, and I am sure we will hear a great deal about that from other noble Lords. We know, for example, that informal carers contribute services worth an estimated £119 billion a year at least. If the informal care sector fails, the burden falls on the formal sector. People do not want to be dependent and are keen to live independent lives.

Connecting Communities brings together many of the organisations that work on small, local health projects. There is a wonderful African saying: health is made at home, hospitals are for repairs. It matches the scientific evidence about creating the right environment in every sense. It is also for us a reminder of the work in the UK of the Early Intervention Foundation.

Let me turn to other sectors: to designers, architects and planners, who can design buildings which encourage walking and the use of stairs, communities where people meet each other and public buildings which bring together different services. I declare an interest as a member of the council of Reading University, and note as an example the work going on there on the built environment. Researchers are looking at topics as diverse as indoor air quality in schools and workplaces and its effect on health and the well-being and educational performance of children and workers, and the relationship between the design of homes and health and well-being.

Moving on to businesses, as well as developing healthy products, they can create healthy environments for their workforce, recognising how much time and productivity is lost every year through ill health. They can both promote health and tackle specific problems, as the firms working together in the City Mental Health Alliance are doing. It is good to see the work of Dame Carol Black as a government adviser raising standards in this area. Schools, colleges and universities can promote health literacy and competencies, integrate healthy activities into daily life and share facilities with health and other services.

I very much hope that my noble friend Lord Mawson will talk about the St Paul’s Way Transformation Project in the East End of London. It is perhaps the most complete example of all these things that I have ever come across. It is about the community coming together with the private sector, education, health and care services: joining up the dots, as I suspect he may say, and informed by an entrepreneurial spirit. It is very much a model for the future.

Of course, government has many roles here. I recognise the importance of the economy and that the aspiration for a higher skilled and higher paid workforce is fundamental to health and well-being. Government is also able to address regulation and legislation, be it on salt, sugar, alcohol or elsewhere. Government can run great public education campaigns, but it also needs to do more to support civil society. I question whether it is doing enough now to build the sort of enabling environment we want, with all the social and community activities I mentioned earlier. It can also support disabled people to live independent lives. I am sure that my noble friend Lady Campbell will have something to say on this, both in this debate and elsewhere.

So there is already an enormous amount going on. Let me note the work of NHS England, Public Health England and other such bodies, local government—I welcome the devolution of responsibilities in Manchester and elsewhere—voluntary bodies, professional associations, researchers and many more than I have listed here. My purpose in this debate is to point to all this and ask how much more we could achieve if we did it in an even more co-ordinated way. I am sure the Minister has a briefing folder bulging with excellent examples of policies, initiatives and activities, and I look forward to hearing about them. There are many out there. However, the Government could do much more in a joined-up way across government, bringing in all those bodies and sectors of society that shape the health of the population. In truth, only Government can really mobilise everyone who needs to be involved.

As the Minister knows, I wrote to the Prime Minister immediately after the election to propose that he and the Government take a big, bold initiative to mobilise all sectors around building a health-creating society. I received a broadly warm reply and understand that the time needs to be right for such an initiative. Now, with winter coming and industrial action planned, is certainly not it, but the time will come for a bold and imaginative commitment to engage all sectors in building a health-creating society. Does the Minister accept this analysis? Will the Government, at the right time, reach out and mobilise all those other sectors to help build a health-creating society—and not, as it so often appears in the newspapers, leave it all to the NHS, government and individuals?

There is also a challenge here for all political parties. I meet a lot of people working in the health and care system and I observe two things. One is frustration, depression and sometimes even despair about the future. However, when I listen to them I also hear a common vision of what that future might be like. In summary, and in very simplified form, this vision is of a transition from the current hospital-led, professional-dominated and fragmented system where things are done to and for patients, to a much more seamless people and community-based one where patients and communities play their roles alongside professionals. This is a vision of high-quality services, delivered in homes as well as local facilities, with a different infrastructure and far greater use of technology. My noble friend Lady Lane-Fox has talked about that, and I suspect she will do so again. With these changes comes the potential for both higher quality and lower costs.

This vision will require major change. I have no doubt that it will require the closure of some hospitals and changing roles for staff. This will be difficult, both practically and politically, and will need political support. The challenge to the political parties seems to be that we need a shared vision for the future and some cross-party political will to make this happen. There will be plenty of political differences about the means of getting there but it seems that this end, this sort of vision, is common ground.

We already have some elements of such a vision in current policy: the Five Year Forward View is very good and has a lot of support, but is ultimately a technocratic and managerial document—I know because I have written such documents in the past. There is a need for a broad-based, cross-party coalition of agreement about what the future looks like. I do not know how that should be achieved, whether through some appointed commission or otherwise. What I do know is that people in the NHS and the country more widely would benefit from clarity of vision and strategy.

Your Lordships’ House also has a role here. It has very often led the way in discussing new and coming ideas and influencing the future. I think of debates I have heard here, for example, on genetics and, most recently, on securing parity between mental and physical health. Noble Lords from all sides of this House argued that case cogently and ultimately very successfully. I hope we might be able to do the same sort of thing here. I note that we are presently asked if we want to put forward proposals for ad hoc committees. I wonder if we should put forward one on building a health-creating society, so that these important ideas can be deliberated on in much more detail than the five minutes noble Lords have today allows. I would be interested to know if noble Lords thought that a good idea and would like to join me in making such a proposal.

Let me finish in optimistic and mildly jingoistic style. The UK is a great world leader in health. We have astonishing strengths in academia, the NHS, the role of DfID globally, the voluntary sector and our commercial organisations. The UK was a pioneer in providing a National Health Service that covered everyone in the population. It would be wonderful if we could lead the way again in moving beyond the professionally dominated and rather industrialised system of service to build a health-creating society served by a modern, fit for purpose health and care system. That would benefit us all as individuals, and bring with it wide-ranging benefits to the country in both prosperity and health. I beg to move.

--- Later in debate ---

[Lord Crisp]

My Lords, as I said at the beginning of the debate, I am very conscious that this is the last business of the day, so I will not detain the House for any length of time. I just want to thank noble Lords for the outstanding contributions from all parts of the House and for the wisdom, experience, imagination, practicality and practical experience that they have brought to bear to the debate. I have learnt a lot, not least about the Isle of Axholme and Bath, and indeed I intend to visit the Hindhead Tunnel—when I say it like that, I make it sound a bit like a pub, which is perhaps appropriate.

We have heard three impressive maiden speeches covering the health and well-being hubs in north Lincolnshire, personal responsibility and the role that government should play, and the importance—this was also drawn out by other noble Lords—of sociability and social networks.

There are four big themes, which I shall set out briefly. The first is the role of the Government. At the beginning of the debate, the noble Baroness, Lady Jay, spoke about needing a Cabinet-level Minister to provide some real drive and traction. The second theme, which I was slightly surprised to hear so much about, concerns relationships, sociability and loneliness. Many noble Lords raised that issue, which is of fundamental importance. The third theme is concern about vulnerable people and inequality, with the recognition that we understand that social structures affect health. The final theme is innovation and imagination, and the fact that there are new things which we can do and which we need to deploy.

Noble Lords will not be surprised to hear that I do not want to leave this subject here. A lot is happening but, as I said at the beginning, it is not being done with enough scale and co-ordination—or perhaps “oomph”, to use a technical expression. Therefore, I will be pressing for an ad hoc committee to dive deeper into these issues and to find practical ways of moving this issue forward.

Motion agreed.