Albie Amankona is Head of Operations and Growth at his family’s business, CreateBeautiful Ltd and works freelance at Thread, a leading high-growth fashion-tech and machine learning startup based in London.
Getting to the heart of the NHS
If we were to forget everything we knew about our NHS, and heard the words “National Health Service” for the first time, what would we think of? A service to stop our nation from getting sicker? Or a service to keep our nation healthy? Indeed, there are similarities in these descriptions, but an important distinction keeps them apart. The former is what our NHS is – a state-funded insurance policy for when things go wrong. The latter is what we might think the words “National Health Service” meant, if we heard them for the first time today: a service to keep our nation healthy. With this in mind, it is time to reimagine what our NHS is for – and it is only the Conservatives who can propose this reimagination.
Broadening the debate
Politicians need to move away from the limits of our current NHS debate: state delivery of more resources for a “better” NHS versus a state programme of cuts and reforms for a “better” NHS. This is a debate which Labour will always win. Conservatives have tried to make the NHS more “conservative”, by introducing a role for the private sector and making spending decisions aimed at delivering efficiencies.
However, the words ‘private sector’, ‘cuts’ and ‘compassion’ are seldom used in the same sentence – and with good reason. For as long as the Conservatives answer to the NHS crisis is the private sector and ‘efficiency’ cuts, we will always lose the political debate, simply because it is neither compassionate nor good enough.
Winning the debate and solving our NHS crisis could be the key to both caring for the citizens of Britain and winning the next General Election – both pretty good incentives to getting the answer right. In order to do this, we must move the debate away from the governments that fund the NHS and onto the individuals who use the NHS. In many cases, it is our actions as individuals which result in our need to use the NHS: what we eat, how much we drink, if we smoke and whether or not we are physically active. Our modern British lifestyles are the most sedentary we’ve ever lived, a picture painted by the British Heart Foundation’s Physical Inactivity Report 2017 which found that 39 per cent of Britons fail to meet government recommendations for physical activity.
NHS statistics on smoking, obesity, alcohol and type 2 diabetes reveal that our unhealthy lifestyle choices could cost the NHS at least £24.4 billion of its £116.4 billion budget per annum (around one fifth of the NHS budget). A state which focuses on keeping the nation healthy, as opposed to one which stops the nation from getting sicker, is a state which could both reduce our NHS budget, solve our crisis and care for the nation. This is how the Conservative Party should present an alternative vision – one which focuses on individual agency to counter Labour’s decades old argument of “more money solves the problem”.
The road to a healthier Britain
Building a healthier Britain requires a cross-departmental approach that encompasses health, transport, education, business and the Treasury. The aim of government must be to make healthy living easy and unhealthy living difficult. Businesses which create healthier working environments should be given tax incentives to do so. At MP and councillor level, this means the continued advocacy and provision for better public transportation and cycling provisions in all regions of the UK, not just London and the South East.
It cannot be a pure coincidence that 47 per cent of the population in North West England do not meet physical activity guidelines, and public transport spending in the region is among the lowest per person in the UK. Larger-scale regional projects like HS2, the Northern Powerhouse Rail, the Midlands Engine, MetroWest and the continued improvements of rapid transit in Liverpool, Manchester, Birmingham and Glasgow must include adequate provisions and incentives for travellers to walk, cycle or use improved local rail and bus services to get to their local transit stations rather than drive. The benefits of integrated transit networks must not be limited to the confines of the M25.
The success of London’s cycle rental and super highway scheme implemented by the former Conservative Mayor, Boris Johnson, can be replicated in our all our largest towns and cities. Adequate provisions for private cycles should be created in our small and medium-sized communities. This needs to be coupled with emissions and congestion charges for motor cars, disincentivising driving and providing revenue to pay for grants rewarded to councils and constituencies who create and nurture our future British culture of cycling. Making cycling and public transportation the easiest way to move around our towns and cities will go a long way to allow more of us to lead healthier day to day lives and reduce our individual burdens on the NHS.
Our healthier Britain must be underpinned by our NHS
It is estimated that 30 per cent of disorders treated in our hospitals are exacerbated by smoking. Our A&E departments are swamped every weekend with the fallout from a binge-drinking culture; tackling this will mean making some tough and at times unpopular decisions.
One such decision could be the introduction of partial charges for patients suffering as a direct result of their unhealthy lifestyle choices. Is it right that broken noses due to workplace accidents and drunken brawls are paid for in equal measure by the taxpayer? The National Health Act of 1946 said that treatment should be free at the point of receipt, with some exceptions. One such exception in section two was cases where the illness or injury is self-inflicted.
As Conservatives we should not be afraid of making tough decisions. With this in mind, those who inflict injury upon themselves as a result of drunk and disorderly behaviour, smoking and bad dietary choices should be expected to shoulder some of their burden on our NHS as its first act recommends.
The possibility of partial charging prompts a broader debate: should the NHS limit what it does? It is a question that could warrant an entire New Blue Book chapter alone.
Whether the individual shouldering of these burdens is implemented through direct charges after treatment, or the introduction of specific tax codes for this purpose is a matter for political debate. The ‘how’ is less important than the ‘why’. Even if £5 billion of the £24.4 billoin the budget for these avoidable disorders can be clawed back for spending in other NHS areas, it would go a long way to funding the disorders caused by misfortune rather than maltreatment and towards building a healthier Britain by discouraging unhealthy behaviour with financial penalty. In the longer-term, changes of behaviour and culture associated with financial penalties could free up precious beds for those most in need.
The disciplinary approach described above cannot work on its own: like most good policies, it works well with education. From a young age, our children must be shown the importance of a good diet, moderation and physical activity. Communities with the biggest problems with obesity, diabetes, smoking and binge drinking must be educated and lifted out of their unhealthy habits. It is critical to note that of the £24.4 billion spent on these avoidable disorders, much is spent on patients whose disorders are not self-inflicted in the same way: alcohol and drug addiction sufferers and those with eating disorders for example. There is a distinction between treating an alcoholic and treating a drunk and disorderly patient.
Conclusion: a paradigm shift
There needs to be a paradigm shift in British government policy and culture. Our state should work to keep us healthy and allow us as individuals to be responsible for our actions. To both care for the nation and reduce our deficit, a Conservative government needs to be bold and move the debate away from the current simplistic argument which Labour seems destined to win. We cannot let the health service be won and lost in a policy context by the party that simply pledges to sign blank cheques.
We should adopt a multi-departmental approach and create a healthier British culture, one of good diet, exercise, walking, cycling and public transportation. This will come from education reforms, tax incentives, investing in infrastructure and the introduction of congestion and emission charges in areas where these investments have been made. As the cycle schemes of London have shown, there is a place for public-private partnerships.
We need a government that is unafraid of being tough on our unhealthy lifestyles and on the alcohol, tobacco and fast food companies who promote them. This needn’t be bad for business – we have seen how the tobacco industry has adapted and created healthier smoking alternatives. The aim of government must be simple: to make healthy living easy and unhealthy living difficult. In order to realise this aim, win the debate and solve our NHS crisis, we must move the debate away from the governments who fund the NHS and onto the individuals who use the NHS. With this in mind it is time to reimagine what our NHS is for and it is only the Conservatives who can propose this reimagination.
This chapter forms part of a series contained in the New Blue Book: Emerging Leaders Edition. It provides a platform for new ideas and policy proposals from rising stars and emerging leaders across the centre-right.