A cross-party commission made up of health experts and MPs, has proposed transforming the NHS from a “reactive” 20th century health system to a “proactive” 21st century health creation service.
The proposal comes amid predictions that the UK is on track for its number of people economically inactive due to sickness to climb by 54% – to hit 4.3 million by the end of this parliament.
This is according to findings from think tank the Institute for Public Policy Research’s (IPPR) cross-party commission on health and prosperity.
The commission, chaired by surgeon Lord Ara Darzi (pictured) and professor Dame Sally Davies, former chief medical officer for England, has concluded its almost three-year enquiry into the interaction between health and the economy.
The commissioners – who include Andy Burnham, Manchester mayor and a former health secretary, and Lord James Bethell, a former Conservative health minister – find that the UK’s worsening public health crisis is linked to its faltering economic performance.
They say that better health is the most important medicine the UK economy needs for the faster growth that the new government has identified as one of its five key missions.
Among its findings, the commission also said that almost 1,600 fewer infants would have died between 2020 and 2022, if improvements in infant mortality had continued at the same rate as between 2001 and 2015.
The final report from the commission – published the week after Lord Ara Darzi’s review into the state of the NHS commissioned by the government – conducted analysis showing health could solve many of Britain’s most pressing economic challenges, including low growth and productivity.
Economic inactivity
The report concludes that if trends continue, economic inactivity due to sickness could hit 4.3 million by the end of this parliament, up from 2.8 million today.
As of the end of 2023, an estimated 900,000 extra workers are missing from work.
These 900,000 missing workers could mean an estimated £5bn in lost tax receipts in 2024, while better population health could save the NHS £18bn per year by the mid-2030s.
Some occupations – including elementary occupations, and caring, leisure and service roles – have witnessed particularly high rates of workers becoming inactive due to sickness.
The rate of inactivity due to sickness is highest among the working age populations of Northern Ireland, the North East and Wales.
The commission, which began working in early 2022 and was first to identify economic inactivity due to sickness as a major post-pandemic challenge, has concluded that better health is Britain’s greatest untapped path to prosperity.
Its says its recommendations aim to move the NHS from a “reactive, sickness orientated 20th century healthcare system” to a “proactive 21st century health creation system”, working in parallel to the NHS’ ‘sickness service’.
The 10th and final output from the commission sets out a plan to move beyond only intervening when people get sick, towards a system which creates good health in all realms of life – including work, school and home.
Add 10 years
The overarching goal for the health creation system would be to add 10 years to healthy life expectancy by 2055 and to halve regional health inequalities.
To do that, the commission sets out an “oven-ready” first parliament policy programme for the new government’s health mission – covering a new childhood health programme, a comprehensive health industrial strategy to penalise polluters and support innovators, nationwide restoration of critical community infrastructure, higher standards for health at work and more integrated health and employment support services.
Specific proposals include:
- Tax health polluters: including tobacco, alcohol and unhealthy food companies to raise over £10billion per year by the end of the parliament, which could fund new good health schemes such as a fresh fruit and vegetable subsidy
- To establish ‘health and prosperity improvement (HAPI) zones’: modelled on clean air zones, with new powers and national investment to rebuild local health infrastructure – such as swimming pools and green spaces – in the most health-deprived areas
- A ‘right to try’ for people on health or disability benefits: an ironclad government commitment of a guaranteed period where people in receipt of benefits can ‘try’ work with no risk to welfare status or award level, lasting months, for everyone with a long-term condition or disability, regardless of what other reforms to health benefits look like
- A new ‘neighbourhood health centre’ in every part of the country: a one-stop shop for diagnostics, primary care, mental health and public health with a focus on prevention
- To create a new health index: Like GDP, the health index will provide a snapshot of how the nation’s health is changing – in a single number – to help monitor progress
The commission also proposes a ‘new beginning’ for childhood health.
The IPPR analysis also found that there has been a substantial decline in childhood health over the last decade – meaning thousands more infant deaths, tens of thousands more children with obesity and hundreds of thousands more young people with health conditions than had stagnation continued.
The report argues this constitutes a breakdown in children’s ‘health inheritance’ – and is the first time in around 200 years that a generation is not guaranteed to live a much longer, healthier life than the one that came before it.
To get children’s health back on track, the commission also proposes a future generation health plan including universal free school meals, restoration of Sure Start and an end to the Two Child Limit.
Just as education is seen as an investment in children’s wellbeing today and economic prospects tomorrow, so should childhood health be seen as key to our long-term economic outcomes, the report says.
Rising sickness
Lord Darzi, former health minister and co-chairperson of the commission on health and prosperity, said: “Our commission was among the first to identify the rising sickness as a major and immediate post-pandemic fiscal challenge.
“Now, as the government sets up its health mission, our final report provides a ready made policy vision for a new approach to public health.”
Dame Davies, former chief medical officer for England and Wales and co-chairperson of the commission, said: “I have long argued that better health is Britain’s greatest, untapped resource for happiness, economic growth and national prosperity.
“This commission has now provided the irrefutable evidence that this is true. A government that wants to deliver growth, sustainable public services and fairness throughout Britain needs to take note.
“One of the most impactful choices they could make is to prioritise a new beginning on childhood health.
“No one would question that education is both about a child’s immediate wellbeing and their long-term economic prospects. The same is true for health.
“We simply should not tolerate decline in our children’s health any longer – it is time for bold action to ensure a health inheritance for future generations.”
Lord James Bethell, former health minister and commissioner, said: “For too long, the default political answer to this country’s health crisis has been more of the same: more doctors, more hospitals, rinse and repeat.
“This commission now proves that disease and bankruptcy beckon if we unthinkingly continue with this ineffective approach.
“It’s time to think differently.
“There is no more exciting vision for the future of Britain than in the reform agenda put forward by this report. It’s time for a new health policy where we all play our part – businesses, employers, investors, individuals, communities and families alike.”
Whitehall silos
Andy Burnham, mayor of Greater Manchester and member of the commission on health and prosperity, said: “As the report concludes, we will never to be able to treat our way to a healthier nation.
“The time has come for the UK to become much more serious about prevention.
“Devolution in England is the game-changer we need to make this possible and improve the health of the nation.
“Combined authorities are breaking down the Whitehall silos and piloting new whole-person, whole-places approaches to health creation.
“The single biggest thing we could do to improve public health would be to give all people the foundation of a good, secure home.
“That, coupled with an overhaul of the benefits system to make it a positive Live Well service, could save the NHS billions.
“Greater Manchester is ready to pilot this new approach as part of the recommendation for health and prosperity improvement zones.”
Chris Thomas, head of IPPR’s commission on health and prosperity, said: “We are not the first generation to face a reckoning with our health. Indeed, one of Britain’s proudest legacies is its history of bold action on health crises.
“The Victorian answered infectious disease outbreaks with sanitation, slum clearance and worker rights.
“Post-war, we answered rising acute need by extending universal healthcare coverage.
“In 2024, we face a health crisis just as pronounced – with unthinkable human and economic cost.
“We have set out to find an answer just as bold as those that came before it. Founding a health creation system is a way to fundamentally reimagine health policy – fit for the 21st century.”