As everyone except the Department of Health and Social Care (DHSC) knows full well, NHS England is too big for its own good. If NHS Scotland, itself far bigger than the NHS in Wales or Northern Ireland, is the right size, then NHS England should be split into autonomous regions. And it should be focussed on its core role of cure and treatment rather than provide beds for those needing social care, send their staff overseas to help other countries with their health services or nanny to those engaging in activities of which the DHSC disapproves, such as eating the wrong food, drinking anything except water and failing to take an extra 10,000 steps a day. If I succeed in getting an appointment with my GP, the first half of the allocated 10 minutes is taken up with being told (again) to desist from smoking my two cigars a month. My GP does not then get a chance to diagnose my ailment, still less cure it.
On 11th September the Health Secretary gave a strategic speech on “How we make public health for for the future”. This is what should have been the nub of his talk "The Department of Health and Social Care has polled people across the country on prevention, from all age groups, from all backgrounds, so we can understand what the great British public think, and what they expect from us.
And there were 2, clear, overriding messages:
the overwhelming majority of people believe the responsibility for their health lies with them – the individual, not the state. I think this is a good thing and should underpin our approach – we must do more to empower people to look after their health
that our efforts on prevention must be focused on children
Sensible people, the British public – we should listen to them more often.”
What follows is a precise contradiction, so much for “listening”. “I do not like the phrase ‘nanny state’, like some critics say, but what I do like is an active state with active citizens. So personalised prevention means the government, both local and national, working with the NHS, to put prevention at the heart of our decision-making.” We must treat “health as a shared responsibility between an active state with active citizens. All of the constituent parts: local authorities, national government, the NHS, communities, individuals, everybody in this room, everybody who believes in the power of public health, playing their part."
Mr Hancock seems unaware of the dictum “if something should be everyone’s responsibility, then it will be nobody’s.”
Of course prevention is important, and so is social care, but that does not make either the responsibility of NHS England. In fact, the DHSC already has a unit, Public Health England, employing, in 2018, 5.283 staff and a budget of around £4bn. Public Health England is entirely separate from NHS England. Here’s an amazing idea: why doesn’t Public Health England take care of public health, adult social care look after care and let NHS England focus on cure and treatment?