23rd March 2016
Hail To The Chief
First off and in the interests of full disclosure, I should mention that I work for NHS England and that Simon Stevens, while not my direct line manager, is my ultimate boss. Now we have dealt with that I wanted to write a few words on the announcement made earlier this month that NHS England will be working with ten housing developments across the country to develop healthier communities. These will be known as Healthy New Towns (HNTs).
These range in size from just under 400 homes in Bicester to over 10,000 in Barking. It was inevitable, I suppose, that phrases such as nanny state would be tossed around and there have been some satirical takes on the announcement – the best being from the ever amusing Julian Patterson here.
Another more serious charge was that Simon Stevens was stepping outside his operational remit of running the national commissioning body (NHS England). But in fairness to Mr Stevens this is a programme of work he committed to in his Five Year Forward View published in 2014 which sought to develop a strategy for how health and social care needed to change as we move into the 2020s. Within the forward view is the explicit aim of narrowing some of the horrendous health inequalities we see in England.
For example, the life expectancy for a male born in Darlington (one of the HNTs) is six years less than it is for his peer born in Kensington and Chelsea. Just as importantly the man from the North East will be more likely to spend his later years beset by one or many chronic conditions, both physical and mental. It’s not credible to deny that there are issues here; issues that not only inequitably impact on some communities’ general health, but also have negative consequences for the local health and social care system’s ability to look after such an increased burden of disease.
The HNTs programme will seek to work with affordable housing developments to make people’s health and well-being a priority. This is an attempt to make public health as much about the space around us as it is a warning people about the dangers of eating and drinking too much – important though those are. While modifying our own personal behaviours is achievable, though extremely hard at times, the ability to change an unhealthy environment (noise, air pollution, lack of green space etc) is beyond all but the very wealthy of us. This is of particular concern when children born today may well have some of their later poor health ‘locked in’ from a very early age. Our good health – not to mention the sustainability of our NHS – requires us to take action not just to treat the consequences of unsatisfactory environments, but to tackle the problem at root.
Next year will see the 75th anniversary of the Beveridge Report and while I suspect Mr Stevens wouldn’t welcome the comparison it does remind us that sometimes the big ideas on a large scale can help to meaningfully transform lives. The devil, as always, will be in the detail and how effectively such strategies can be made to work on the ground. But these ideas could be particularly powerful when local communities along with the private and public sectors come together to attempt to make them a reality. So let us allow ourselves to be positive and think big; we owe it to ourselves.
By Steven Duckworth