It’s been an interesting few months for the NHS – some very high-profile birthday celebrations to mark its 70th birthday, a Budget that saw most of the increase in public spending pledged to the NHS, and this week a prime minister who is "determined to do what it takes to secure our NHS for the future so that it is here for all of us".
These are big commitments to take us into the next year, never mind several decades.
There is no question that the overall health of the population in England has improved greatly over the past 70 years, but the health challenges of 2018 are very different to those of 1948: we live longer, we smoke less, but other "lifestyle diseases" are still prevalent and cost millions to address.
The focus of our health spending is largely on cure and rehabilitation rather than prevention. Something that the health and social care secretary Matt Hancock has acknowledged, saying that "prevention is better than cure". He has plans to help people take responsibility for staying healthy and the NHS’ forthcoming 10-year plan is expected to include a big push on this, including social prescribing – encouraging people to take part in community activities as part of their treatment.
A healthier nation
We think part of those plans must focus on learning and work, and the role they can play in working alongside the NHS to ensure a healthier nation. There are clear links between learning and health: many international surveys show that people with higher qualifications tend to enjoy better health, and levels of qualifications are also linked to how we make use of the health service, and how we manage our own health and the health of those we care for.
Similarly, workplaces are critical to our health. Many people spend a large part of their lives at work and increasingly have longer working lives. Generally speaking, work is good for us – but it has to be "good" and "fair" work – precarious and insecure employment can be harmful for our health.
To investigate this further, Learning and Work Institute polled 3,000 adults across England over the summer. We asked them what they thought about their health in general, how well they knew how to keep healthy or improve their health, and which three changes they thought would help them to keep healthy or improve their health.
The poll showed that many of us have very different views on how healthcare spending should be allocated. For example, older people are more likely to favour investment in hospitals, while younger adults favour a more balanced approach including social prescribing and preventative models. Those in poorer health are least likely to say they know how to improve their health. Generally speaking, the public seems to think a more balanced range of approaches is appropriate.
This is a critical finding at a time when government has pledged more funding for the NHS. How that plays out is important.
Our report ‘Learning, work and health: the next 70 years’ proposes six big challenges to support greater coordination of health, learning and work:
- Future funding of healthcare needs to better address the social determinants of poor health. Prevention is better than cure. Social solutions, such as access to learning and support to work, can also be part of supporting people with health conditions. The Budget announcement is a golden opportunity to do this, as would increased investment in public health initiatives that link more closely with other devolved funding, such as the adult education budget, and the joint Work and Health Unit.
- A coordinated approach to health and associated services, including adult learning and employment services, should be adopted locally with multidisciplinary teams to avoid unnecessary duplication.
- Social prescribing to support learning linked to health, work and communities should be extended across the UK. We argue that linking social prescribing with entitlement to a personal learning account would help give people greater choice and ownership over their learning, as well as flexible help with the cost.
- Person-centred curricula, using an asset-based approach, to enhance capabilities and existing knowledge, should be adopted, again making use of multidisciplinary teams.
- Government should accelerate plans to transform how we support disabled people into work, to stay in employment and to progress.
- Devolution Deal areas should work with government to set out how they will halve the disability employment gap together and then develop "local labour market agreements" to deliver it.
The NHS is not a single organisation but a set of inter-related services which need to work more closely in partnership with social care, local learning and employment services, and employers themselves, to give everyone a fairer chance in life.
Earlier this week, Matt Hancock said that "prevention saves lives and saves money". Work and learning have a big role to play in this. Inter-connected issues require inter-connected solutions.
Joyce Black is deputy director for research and development at the Learning and Work Institute