The NHS as an Anchor Institution

The Preston Model of economics has set many heads turning and tongues wagging! If you don’t know the story, it is well worth reading about, as it offers much hope for the future. Alternatively, you can hear Cllr Matthew Brown talking about it here.

 

If the NHS really took on board what it means to be an anchor institution, as the largest employer in the UK, it could have a seismic effect on the economy, the environment, the health and wellbeing of the people and social justice. It is well within the gift and grasp of the NHS for this to become a reality, both locally and nationally and would involve some basic and fairly straightforward changes (and some more slightly complex ones!) Here is a starter for 10:

 

1) Pay everyone in the NHS a living wage

2) Reinvest the NHS pension pot, taking it out of global corporations or off shore tax havens and instead putting it into local infrastructure and regeneration schemes

3) Ensure the physical and mental health and wellbeing of all staff, through developing the 5 ways to wellbeing in the work place and leading by example by ensuring healthy food options for patients and staff. This could also include all staff having 1/2 day per month to volunteer with local charities, communities and schools around health and wellbeing initiatives

4) Create positive discrimination to employ people and offer apprenticeships/training opportunities to people from more economically deprived neighbourhoods (as per Oldham) to help generate more economic wellbeing

5) Only procure from local/regional companies, again to improve local investment and ensure these companies also have a good health and wellbeing strategy for their own staff

6) Take responsibility for developing a green strategy

7) Join with other large local employers to develop this wider strategy and economic development plan, e.g around green transport, job creation and supporting worker cooperatives – this needs to include local councils and universities

8) Be part of the new local bank/credit unions being set up so that new banking systems are more accountable

9) Work with local schools which are struggling, and create healthy school partnerships which both secure the wellbeing of future generations and can create a more committed and secure workforce through new training schemes

10) Support the community voluntary and faith sector with both practical resource and infrastructure support through the primary care networks and integrated partnerships

 

This is by no means an exhaustive list, just a few examples. Imagine, though, what a huge difference it would make if NHS England, every Integrated Care System, each Integrated Care Partnership and every Primary Care Network adopted this kind of plan. We might focus less on the effects of poverty on health and more on what we can do to make a difference to it, because we would be a part of generating wealth and improving health! This takes the NHS into the doughnut and creates an economy of wellbeing – why wouldn’t we do this?! It’s easy to understand and not too hard to implement!

 

 

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Choice and Responsibility

There is growing rhetoric in the media and within the NHS that the public needs to make better choices and take more responsibility for their own health. Who wouldn’t agree with that? Surely, we are the ones who ultimately choose what goes into our bodies – we choose our sugar intake and decide how much exercise we take, don’t we?

 

Well, given Philip Alston’s damning report on the the state of poverty and human rights in the UK, perhaps we should think a bit more deeply about this!

 

When we say that people ‘just need to make better choices and take more responsibility for their own health’, we need to recognise that it is far easier for some people in our communities than for others. When you’re living in poverty and you would have to spend over 42% of your income to eat the government’s recommended healthy diet, your choice is reduced. When you live in an area in which there is a far greater number of high street take-aways, due to how licencing works in your town and you can fill the hungry belly of your child with a £1 sausage roll or bag of chips, and you don’t have a microwave, or you can’t pay the electric bill because you’re on a scandalously expensive meter – then your choice is reduced.

 

When the transport you reply on to get to the shops has been cut and your nearest shops don’t sell much fruit or veg, so you fill up on carbohydrates and sugars, which meet your hunger, but increase your risk of diabetes – your choice is reduced. When you suffered several adverse childhood experiences in your early years and have never been able to get healing for the trauma and continue to find comfort for your pain in the food that you eat – your choice is reduced.

 

When the products you buy are now filled with a much higher calorie load than they were 20 years ago, and hidden sugars you didn’t even realise you were eating – then your choice is reduced. When you are one of the ones ‘back at work’ (because let’s remember there are more people in work now than ever before), but you’re on a zero hours contract and so you’re working 2-3 jobs a day, just to pay the rent, let alone the bills and getting no breaks in which you can sit down to actually digest your food, let alone make healthy choices from the work canteen that doesn’t actually supply any healthy choices – then your choice is reduced. When you are scraping everything together to make sure you don’t fall into more debt, whilst you are sitting with a benefit sanction for something that really wasn’t your fault and you are using a food bank for your meals and so healthy options are not in abundance (and let’s not even go there with sanitary products and how utterly dehumanizing the tampon tax is) – then your choice is reduced. When you have been kicked out of school because a no-tolerance policy left you in isolation or no-compassion and then you’re a drug runner for a local gang, where you feel like you fit in, but in fact, they own you….then your choice is reduced.

 

Let’s be a little more kind, can we? Let’s stop stupidly over-simplistic comments like – people should just take more responsibility for themselves. This is actually pretty impossible for nearly 14 million people in the UK. I’m not saying there is no choice and nor am I saying that people have no responsibility. I’m simply reminding us that it is a great deal easier for some than others and we are seeing child poverty on the rise and the health inequality gap widen – this isn’t because people in poverty are making bad choices – they simply have far less choice available to them!

 

So what needs to change? Government policy around austerity and universal credit, licensing, pricing, advertising laws, a living wage, the way we work with communities rather than doing things to them, a total renewal of our education system and a bunch more kindness in society as a start.

 

 

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Obesity – Genetic or Environmental?

Tweet Obesity has become part of a serious blame culture. “Just eat less and exercise more”, seems to be the simplistic argument these days. Social media is full of ‘fat shaming’ and the public opinion has shifted much more towards it being people’s own fault if they are fat – “they should just make better choices and [Continue Reading …]

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Facing Our Past, Finding a Better Future – Adverse Childhood Experiences

Tweet This week I had the privilege of listening to Prof Warren Larkin, advisor to the Department of Health on Adverse Childhood Experiences. This is something I’ve written about on this blog before and Warren has made me more determined than ever to keep talking about this profoundly important issue. This blog draws on his [Continue Reading …]

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A-Z of Health and Wellbeing

Tweet Happy New Year!   We often start a New Year with resolutions, things which we would like to change for the better. so, I thought I’d start this year of blogging with a vlog about my perspective on the A-Z of what affects your Health and Wellbeing the most.   It’s longer than most [Continue Reading …]

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Who is Responsible for Your Health?

Tweet Who should take responsibility for you health? Sounds like a straightforward question, doesn’t it? But I get so frustrated when complex issues get squashed into simplified, silo-thinking, ready for twitter or media sound bites, or the under-girding of political ideologies. So….just as the economy is not just made up of the interplay between business and [Continue Reading …]

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We Need to Be Ambidextrous in Solving our Health and Social Care Conundrum

Tweet All this week on the BBC, there has been a focus on the NHS and the crisis we are in – don’t panic Mr Mainwaring…..There is a heady mix of opinions being thrown around – Question Time became quite a furore of ideas and thoughts last night – not enough beds, not enough staff, not [Continue Reading …]

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