23rd October 2024
Health Secretary, Wes Streeting – big plans for the NHS but will they be big enough?
With only one week to go until the first budget from Labour Chancellor, Rachel Reeves, there has been much speculation about what it will include, in relation to both spending cuts and investment to allegedly boost the economy, usually a euphemism for increasing coprorate profits. As part of the pre-budget media management Health Secretary, Wes Streeting, has shared a vision for the NHS, or at least initiated a “national conversation”, with a 10 year plan for the NHS to be published next year.
As well as digitisation of patient records, controversial with many, the government is proposing neighbourhood health centres where patients will be able to see family doctors, district nurses, care workers, physiotherapists, health visitors and mental health specialists, all locally and under the same roof.
There will also be shift in focus, from sickness to prevention, with the aim of shortening the amount of time people spend chronically unwell and preventing ill-health. There are also plans to provide smart watches for people with diabetes or high blood pressure, so they can monitor their own health at home.
Some of these measures may have benefits but while smart watches to monitor conditions could address the symptoms it will not get to the root causes of economic disadvantage and poverty, which result in poor diet and cheap food choices, which many working class families are forced into.
At the same time, in a contradictory move, the government has approved the trial of an anti-obesity drug aimed at getting “those who are most likely to return to the labour market” back into work. The trial, based in Manchester, will involve 3,000 people in a five year study of the “non-clinical outcomes” of treatment to see if it encourages a return to the workplace.
The trial effectively treats people according to “their economic value, rather than primarily based on their needs and their health needs”, according to obesity researcher at Cambridge University, Dr Dolly van Tulleken. The emphasis of this approach is once again to blame the individual, rather than to highlight failures in the system which, due to lack of financial resources, limits options for many working class families and exacerbates health inequalities.
Quite apart from the ethics of such an approach it is nothing more than a sop to Big Pharma, always keen to explore drug based solutions, when a huge evidence base for the benefits of alternative approaches to preventative health care already exists.
The National Centre for Creative Health (NCCH) was established following the All Party Parliamentary Group on Arts and Health report, Creative Health, published in 2017. A subsequent commission, established by the NCCH and chaired by Baroness Lola Young, published its Creative Health Review in 2023 to update the findings of the original APPG report, in the light of the Covid-19 pandemic.
While a commission made up of the great and the good from the worlds of health and culture was never going to come up with a set of revolutionary demands, it has nevertheless highlighted flaws in the existing health and social care arrangements, which could be addressed to benefit working class communities if resources are made available.
The review set out a number of recommendations to government, primarily,
- the development of a cross-departmental Creative Health Strategy, driven by the Prime Minister, co-ordinated by the Cabinet Office and supported through ministerial commitment to ensure the integration of creative health across all relevant policies. Such an approach will facilitate the establishment of sustainable cross-sectoral partnerships across regions and systems, modelled by national policy.
- The long-term value of investing in creative health must be recognised and appropriate resources should be allocated by HM Treasury to support the Creative Health Strategy.
- Lived experience experts should be integral to the development of the Creative Health Strategy.
While these demands in themselves are relatively limited they are still a challenge to the conservative approach to health and social care taken by both the Tories and Labour in government.
Creative Health is defined as creative approaches and activities which have benefits for health and wellbeing. Activities include visual and performing arts, crafts, film, literature, cooking and creative activities in nature, such as gardening; approaches may involve creative and innovative ways to approach health and care services, co-production, education and workforce development.
Creative Health can be applied in homes, communities, cultural institutions, heritage sites and healthcare settings. Creative Health can contribute to the prevention of ill-health, promotion of healthy behaviours, management of long-term conditions, and treatment and recovery across the life course.
The Creative Health agenda is not just about tinkering with the NHS system and social care at the edges, it is about a wholesale reform of the approach to healthcare, which emphasises active community engagement in a range of creative activities. In study after study, both nationally and internationally, these have been proven to have positive impacts. The key to success however is that activity must be effectively funded at a community level and this has been systematically reduced by successive governments.
The squeezing out of arts activities in state schools, as part of the national education curriculum, will have a long term impact upon the ability of those other than the wealthiest to access creative resources. Grassroots arts activity is under threat across the country as venues and community facilities close due to the rising costs of stock and utilities. Local government arts budgets have been cut to the bone with arts, museum and library facilities continually under threat. Yet these very services are integral to the physical and mental health and wellbeing of local communities and should be at the core of any proposals which have prevention at their heart.
The Tories cut funding to the Arts Council England by 30% when elected in 2010 as part of the austerity agenda, claiming that support could be found by unlocking the potential in philanthropy. That ship has yet to come in to dock. The Office for National Statistics in a report in 2022 showed that while more than 16% of creative workers born between 1953 and 1962 were from working class backgrounds, that figure had fallen to 8% four decades later.
The number of students taking arts GCSEs has fallen by 40% since 2010 and the number of drama teachers in English secondary schools is down by 22% since 2011.
Such figures demonstrate the lack of value placed upon the creative sector, in spite of it being a huge income generator for the economy, over £108 billion in 2021, but also the failure to recognise the essential role creativity can play in reducing the burden upon the NHS as part of an integrated Creative Health approach.
The “national conversation” Wes Streeting has initiated needs to highlight these facts and the next 10 Year Plan for the NHS needs to have Creative Health and the real needs of working class communities at its heart. In addition, investment in the cultural sector, both through Arts Council England and the local government sector needs to be restored as a priority and the basis of arts education in the national curriculum reviewed.
Creative Health is unlikely to get much airtime in Rachel Reeves’ budget next week but if it is not taken seriously, as part of a wider package of investment in and reform of health and social care, the long term health of the nation, and the government, will be in doubt.
Avanti Populo 