There is a village near where I live with a population of just over 5000. It was established as a colliery, but the pit closed in 1981.The signs of economic decline are rather obvious, but what strikes you most when you walk down the Front Street is the number of fast food outlets – six at the last count, with two shops which concentrate on cheap alcohol. There are also two large care homes.
Here in microcosm are the problems facing our health service. Economic decline has brought bad health and the resulting bad habits. There is also a large, and growing, population of the elderly for whom care has to be provided. It seems to present an enormous challenge.
But things are not as bad as they appear at first. There are many good people in the village who are trying to do something about the situation. There is a lively health centre, with innovative and dedicated GPs and a go-ahead manager. There is a thriving garden association which has 250 gardens and a waiting list. It provides fresh vegetables which are sold at the community centre.
The community centre itself has been pro-active in attracting funding, and now runs a range of activities. Currently over 350 people of all ages use a wide variety of services at the Centre including healthy living activities such as skipping, indoor bowls, tea and line dancing; keyboard classes, IT classes, drama workshops, cake decorating, art classes plus a fitness suite and a Community Café. The latest addition is pilates. They have a lively WI, and the reason I know so much about the place is that they invited me down to speak. Hope they got over it.
What impressed me most about the community, however, is the Health Forum. This was originally set up by the Primary Care Trust, but funding has now been cut. They originally had professional help, but they now run it themselves and have managed to secure funding from various sources. It received a small grant which it used as leverage to attract additional funding, and then distributed it to projects which promoted good health. In the past it has supported various schemes, including a project to install low level lighting to minimise the risk of falls in senior citizens’ bungalows, outdoor ventures for the cadets and other youth groups, and an allotment. The actual spending of the money was properly monitored. All this was done by volunteers who cared about their community and its health.
So there is hope. A community which has been on the sharp end of recession and economic decline, and has experienced their effects at first hand, is doing something about it.
It made me think. What sort of role do we see for the NHS in the future?
We frequently hear about the health risks of bad lifestyles, and how conditions such as obesity are likely to increase. We have managed to tame smoking, but alcohol abuse shows no sign of abating. The NHS will be financially constrained whichever government is in power, and we cannot expect it to solve all our problems alone. Communities must do something to help.
In my book I attempt to set out my ideas about how a community based, democratically run health service will run in the future. If we are to deal with bad health, it is a job for all of us. Despite our problems, we have some examples of very good practice here in the North East where I live, and I want to draw on these to define my vision.
Nigel Lawson once said that the NHS was the nearest thing we had to a national religion.(1) In many ways it is similar to our other supposed national religion, the Anglican Church, which people want to be there if they need it. It is true that people in this country remain very attached to the NHS, but we have to think hard about how it is going to cope fairly and effectively in the years ahead when resources will be constrained. That is a challenge for all of us.
The controversial Health and Social Care Bill (2) is now law. There has been tremendous opposition to it, mainly to the perceived threat of large scale privatisation, and the breaking up of what is regarded as a national treasure. At the next election a future government will be faced with the situation of having to work with the consequences of the new act. Simply repealing it will not solve the problems faced by the NHS. Peter Watt, former general secretary of the Labour Party, commented “Back to the future is hardly an inspirational rallying cry for Labour. Instead it needs to begin to set out what its vision for the NHS is.” (Guardian March 21st 2012)
My book is a contribution to that debate from one who passionately loves the NHS, but feels it must evolve and become more community based. I hope you find it interesting, and it gives you an idea of what sort of health service we can have in this country in the future.
The Future of The NHS by David Taylor Gooby, will be published by Searching Finance in September 2012.