A distinguished group of experts that includes clinicians, scientists, social entrepreneurs and crossbench peers is calling for a radical rethink on health in the UK as the National Health Service "lurches from crisis to crisis" against a backdrop of Brexit.
The group has published a manifesto offering a new vision for a healthy and health-creating society in The Lancet, which, building on the policy, insights and actions of many organisations and people throughout the UK and beyond, proposes action across four simple but closely-linked themes.
For one, transformation of the health and care system from a hospital-centred and illness-based system to a person-centred and health-based system "needs to be accelerated and funded," which will require "a massive increase in services in homes and communities and new ways to empower front-line staff, enabled by technology, to manage the complex needs of patients across different services and organisations," it said.
Many different partners and providers will need to get on board with the process but, above all, there must be "far greater engagement of patients and carers in decision making and care, and enabling them to live as independently as possible".
The authors note that NHS England has already set out its vision in the Five Year Forward View, but stress that "implementation is slow everywhere and the system is struggling with maintaining the old services whilst creating the new - and as a result is facing double running costs and failing to invest in the future".
It was also stressed that this transformation will require funding, noting that the UK currently spends about 30–50 percent per capita less on health than, for example, Germany, Sweden, Ireland, Holland, and Australia.
"Additional funding is needed both to achieve the transformation of the system and to meet the growing needs of an ageing population. At the same time there is a need to bring together health, social care and, potentially, other local service budgets where this is not already happening for maximum efficiency and impact," the group said, pointing to a cross-national analysis of the economic impact of spending in differing government sectors that found spending on health "had one of the highest and most positive returns on investment, yielding up to £3 for each £1 invested".
It was also argued that the UK needs to develop and implement a plan for building a health-creating society that addresses health inequalities.
Current plans for health promotion and disease prevention are "too small scale and fragmented" to make a lasting impact and the NHS spends very little on the area. "It is clear that developing and supporting a healthy population cannot be done by the NHS, health professionals, and politicians alone. Achieving real impact on the health of people throughout society requires leadership and action from all sectors," according to the manifesto.
It argues that national and local government "have the powers and responsibility to shape the environment and provide incentives for building a health-creating society in every area from employment and housing to welfare support, food, and education - as well as enacting laws and regulations that control the use of tobacco, alcohol, junk foods, and other damaging products and practices", but also stressed that "business and other organisations have important contributions to make to health as employers, designers, educators, service providers, and manufacturers".
In parallel, health, care, and scientific institutions must help develop and restore a healthy society in the UK, as "a health-creating society can only be built in a society that itself is healthy," said the group.
These communities "embody values of social solidarity and have a crucial part to play in developing and restoring a healthy society in the UK," and the manifesto stresses that "tackling racism, promoting equality in all its forms, and celebrating innovation and creativity are vital to the sector - and to the country as a whole".
Also a key aim should be to strengthen the UK's role as a global centre for health and the biomedical and life sciences, which "will require all sectors - the commercial life and biomedical sciences as well as the NHS, academia, government, and voluntary organisations - to build closer and more productive links to achieve synergy and impact".
"Investing in the health and life sciences industries is smart economics. The Wellcome Trust estimated that each £1 investment in cardiovascular disease research produced a stream of benefits equivalent to earning £0·39 per year in perpetuity, easily surpassing the UK government's minimum threshold of 3·5 pence per pound for investments," it said.
"The NHS faces severe financial constraints and appears to lurch from crisis to crisis, with leaving the EU likely to exacerbate many problems including staffing issues across the whole sector," note authors of the manifesto, who include former NHS chief executive Lord Nigel Crisp, Lancet editor Richard Horton, and ex chair of the Royal College of General Practitioners Maureen Baker.
"However, new scientific developments and digital technology offer societies everywhere massive and unprecedented opportunities for improving health. It is vital for the country that the NHS is able to adopt these discoveries and see them translated into improved patient care and population health, but also that the UK benefits from its capabilities and strengths in these areas."