The NHS was never meant to go it alone

The inspiration for the NHS came from the 1942 Beveridge report that set out to slay the five giants of idleness, ignorance, disease, squalor and want. His report laid the ground, not just for the NHS, but for the wider welfare state and the post war housing boom, although arguably, his vision for a better, stronger and fairer society has never been matched.  

As the NHS reaches its 75th anniversary it is important to remember the scale of Beveridge’s ambition. And that the NHS was never meant to go it alone. It was always intended to be part of a broader system of support addressing jobs, housing, education and other public services.  

Understandably, the British public has a deep attachment to the NHS as an institution. But if our goal is a healthier society, that attachment can’t be to the detriment of those things that help keep us healthy in the first place. And while the ‘cradle to grave’ support from the NHS is something we all rely on at some point in our lives, Beveridge also recognised that it’s the circumstances we find ourselves in on this journey that also matter. 

The biggest factor in determining how long someone will live isn’t primarily how good their GP is, or how close they live to their local hospital. Rather, it comes down to their wider living conditions. There is currently a 19 year gap in how long a woman can expect to live in good health depending on whether she lives in the most – or least – deprived parts of the country.  

When Beveridge spoke about the five giants, he focused on the problems society faced. In building a commitment to a healthier society it's important to focus on the value of good health and its enablers. Good health means that people can take an active role with their families, in their communities and contribute to the economy. Good health is dependent on having the right building blocks in place – stable jobs, good pay, quality housing and good education. 

And these building blocks are all connected. Take work, for example. When people are in insecure, low paid work, it affects their ability to afford the basics and means it is harder to ensure decent housing. This leads to people living in cold, damp homes that can result in respiratory problems and other health issues. Constantly worrying about having enough money to pay the rent or buy food can also lead to chronic stress, anxiety and depression. We are starting to understand how living with these constant stressors on physical and mental health have a ‘weathering effect’ on our long-term health and wellbeing. 

Our evidence hub, What drives health inequalities?, provides the latest analysis on the relationship between our health and different aspects of our lives – housing, transport, work and income. It also highlights trends in these areas, helping to illuminate the scale of the challenge. For example, in 2018/19, nearly 7 million households were living in housing that fell short on at least one of the aspects that we know are associated with our health – housing affordability, quality and security.

Yet, despite the evidence of the impact of these wider factors on health and wellbeing, the NHS continues to dominate public and policy discourse. Working with the FrameWorks Institute, we have been developing ways to communicate to the public the wider factors that shape health. Our framing toolkit sets out five practical steps that can help people communicate more effectively about the building blocks of health. We know the value people place on good health, and using this toolkit can help move the conversation beyond fixing people when they become ill to focusing on the action that can help people stay healthy for longer. 

Critically the responsibility for this action falls across all parts of society. Government has an essential role, setting the overall policy framework and providing funding. Local government act as the place makers, ensuring coherence across the range of local partners as well as delivering services. But the fabric and richness of local communities is also shaped by charities and the voluntary sector. Business also has a vital role to play, in terms of the quality of work it can provide and the products and services it delivers.  

The need for this whole society effort is embodied in the Health Equals campaign. Health Equals brings together a group of organisations and voices across different sectors, including employment, housing, education and the environment, who all want to make a positive difference to society’s health and wellbeing. Through powerful and evidence-based campaigns, Health Equals is starting a conversation about health and wellbeing that recognises the importance of the building blocks of health and the action needed to create better health for people across the UK. 

In 2020s Britain, Beveridge’s giants still loom large. The aftershocks of the pandemic and the cost-of-living crisis are taking their toll on the nation’s health. But recent analysis shows that even before the pandemic there was an emerging trend of ill health being a factor in the numbers of people leaving the workforce.  

The NHS was never meant to go it alone, it needs to work alongside the wider services and institutions that can deliver warm and affordable homes; that can create secure jobs; and neighbourhoods that foster good health. As the saying goes, if you want to travel fast, go alone; if you want to travel far, go together. 

Jo Bibby (@JoBibbyTHF) is Director of Health at the Health Foundation.

This content originally featured in our email newsletter, which explores perspectives and expert opinion on a different health or health care topic each month.