All eyes have been on the NHS in recent months as it celebrated its seventieth birthday. Politicians spent much of 2018 venerating its founding principles — public, universal, free at the point of use — as consensus ideals across the political spectrum.
This is a substantial departure from the reality of the NHS today, a public institution marketised, privatised, and subject to cuts that threaten its future. In its seventieth anniversary year the NHS was forced to delay around 55,000 operations and employ consultants to turn away patients from A&E that were deemed non-emergency. In many hospitals, ambulances waited outside A&E departments at full capacity, and corridors were lined with patients on hospital trolleys, reflecting the 15,000 beds cut in the last six years.
A 2017 article in the British Medical Journal on the impact of spending constraints on mortality in England estimated that by 2020 cuts to health and social care budgets since 2009 would be associated with over 150,000 deaths. Last year’s winter crisis in the NHS was officially the worst on record, with patient waiting times, bed shortages, and ambulance queues hitting unprecedented levels. From October of 2018, NHS Providers were warning the government that this year would be even worse.
All of this just looks at the headline issues. But the NHS affects public health in a myriad of ways. It employs over 30 per cent of the public sector workforce (around 1.6 million people), and so its employment policies impact the quality, pay, and working conditions of a large section of the population. As a purchaser of services, healthcare organisations spend around £20 billion annually, in turn affecting local and national economic, social, and environmental factors. NHS hospitals alone own around 1,200 sites worth between £9–11 billion. NHS-related traffic accounts for 3.5 per cent of all road traffic in England, which produces an estimated of £345 million worth of potential mortality effects and costs to society in terms of air pollution. As a carbon user, NHS activity accounts for 40 per cent of public sector emissions.
All of these factors have a significant impact on public health — and are largely unacknowledged by government. Employment practices, climate change from carbon emissions, and even city design are all impacted by NHS activity, affecting how we live, our health, and the health of the planet. The latter was emphasised by the 2015 Lancet Commission on Public Health and Climate Change, which produced a stark conclusion: without serious government intervention ‘anthropogenic climate change threatens to undermine the past fifty years of gains in public health’. If the Left is to meet this challenge, we need to look at healthcare more holistically and begin to design an NHS fit for the twenty-first century — one that takes care of the health of the public and the planet.
The logic of privatisation — which not only says the most important metric for healthcare provision is profit, but also removes decision-making from democratic arenas — is ill-suited to meet this challenge. This can already be seen in Britain’s transport infrastructure, where the privatisation of bus and rail services has disincentivised the kind of mass transit that might reduce carbon footprint. Privatisation has also hindered public health outside the NHS, contributing to everything from lower health and safety standards to more frequent disasters in companies like BP.
The health risks of the increasingly-dangerous new methods pursued by the fossil fuel industry, such as fracking, are also clear. A recent study, produced in the journal Reviews on Environmental Health, detailed the risk posed to children’s early development from airborne particulates and heavy metals associated with fracking. In addition, former US Environmental Protection Agency scientist Dominic DiGiulio produced landmark research demonstrating the severe pollution fracking caused to drinking water in Wyoming, one of America’s most fracked states. None of this is even to mention the health impacts of fracking-related earthquakes, which have already been felt in the UK.
So what would integrated pro-environment public health planning in the NHS look like? Initiatives that have reimagined how healthcare can operate in a local area have been remarkably successful. In 2016, Southern Staffordshire Community Energy collaborated with University Hospitals of North Midlands and the Beat the Cold charity to fund the installation of solar panels on hospital buildings and to improve the welfare of local residents living in fuel poverty. The ‘Saving Lives With Solar’ share offer raised £335,600 and was only open to members of the local community, meaning profits were kept locally.
The fund installed over 1,000 roof-mounted solar photovoltaic panels and those who bought into the share offer receive an average rate of return of 4.5 per cent. Some of the money generated by the panels is diverted to Beat the Cold in order to assist local and vulnerable patients who are suffering from fuel poverty and living in cold and damp homes. This initiative has facilitated both energy and community resilience, as well as a positive financial benefit to the local economy, and the hospitals themselves. Across its twenty-year lifetime, over £600,000 is expected to be saved from energy costs to the hospital.
‘Transforming Travel in a Community Trust’ was another successful initiative with the same approach, that aimed to reimagine Sussex Community Foundation Trust’s relationship with travel. The trust, after realising its travel represented an annual cost of over £3 million for 6 million miles travelled, created a ‘Travel Bureau’ to address the economic and environmental cost of the trust’s staff and patient travel. The Bureau now provides fifteen low emission pool cars, a booking service for bus and rail tickets, interest-free season ticket loans, maps and cycle ways, and a route-planning service for clinical staff travel to a new location. After a year of the Bureau, staff had travelled a million miles less, and over half a million pounds were saved. There was a measured increase in local air quality. A more direct effect on health occurred too: staff had more time to spend with patients thus improving the service they were providing.
These projects show us a glimpse of what our healthcare system could be. The untapped potential of integrated initiatives is enormous, and could prevent us from making further short-term NHS policy decisions. Earlier in 2018, the government-commissioned Naylor review recommended that ‘surplus’ NHS land be sold off, to the tune of £2.7 billion. Theresa May has indicated that she will implement these recommendations. Why has the government not reviewed the potential economic, social, and environmental benefits that could result from the installation of clean energy generation on this unused land? Repurposing instead of selling land makes sense both from an economic perspective and also from the perspective of public health and sustainability.
Of course, the reason for this is that the government remains committed to privatisation. But, as the research of economist Mariana Mazzucato makes clear, private investment is unlikely ever to produce the kind of long-term, strategic, and transformative funding needed to bring about a green energy revolution. As in our transport system — where Britain is unlikely ever to break its dependency on cars without taking buses and trains back into public ownership — it’s clear that the future of progressive policy lies in an interventionist state prepared to broaden democratic decision-making and take bold action in defence of the common good. The campaign to renationalise the NHS can best be seen in this context.
The latest Intergovernmental Panel on Climate Change report once again laid bare the scale of the challenge posed by climate breakdown. We have just twelve years to reduce our greenhouse gas emissions by 45 per cent, if we are to stay within the critical limit of 1.5 degrees. The report leaves no doubt about the extent to which we have to reimagine the structure of our economies, energy consumption patterns and lifestyles. If we are serious about tackling this problem, public health must be integrated with sustainability and our local and national economies to both mitigate climate catastrophe and put forward an inspiring vision of healthcare fit for the twenty-first century. Another vision for public health is possible: where the NHS leads the fight against climate change while keeping us healthier than ever before.