By Nigel Crisp
I suspect that most people, if asked, would describe the aim of the NHS as being about curing illness, helping people be healthy and providing good health services when needed. All of these are of course crucial and what the NHS does daily. I believe, however, that we need to go deeper and wider than this and suggest that the NHS shares in a wider aim to help people to have as much independence as possible so that they can live a life they have reason to value.*
This re-definition may at first sight seem both unnecessary and deeply counter intuitive to the professional health worker with many years of education and experience behind them; but in reality it is what most of them do on a daily basis. Many of us by the ages of 50 or 60 have some sort of disability or condition which requires regular attention – whether with statins and other drugs to prevent heart attacks and stroke, insulin to control diabetes or knee, hip and cataract operations to improve the quality of our lives. In all these cases the NHS is clearly helping us to live independently, reduce the burden we might otherwise be on ourselves and others and get the most out of life.
Even with acute conditions – a broken leg, pneumonia or appendicitis – our concern is to recover and “get our lives back”. We want “to be able to live at home and independently”. Friends with disabilities tell me that they may have to rely on regular healthcare but they want to be treated as individuals in their own right and enabled “to carry on their lives as freely as possible”.
Describing the aim in this way emphasises the point that different people value different things and, crucially, that nobody can judge the quality or the value of someone else’s life. Influenced by culture, background, family and personality we make our own choices about health and life even when we are seriously ill or disabled. A friend told me the story of how when she was in intensive care she heard doctors saying that she shouldn’t be resuscitated because her quality of life was so poor. She was horrified. She would be the judge of her own quality of life.
This re-definition is also very important because it recognises and gives primacy to the way the NHS has to work with so many other organisations and people – formal organisations like social services and education; informal voluntary and community groups; and relatives, neighbours, friends and carers – as well as the individual themselves in providing care.
There is another aspect, too. Health is connected with everything else in our society. Health and social issues interrelate at every level. The NHS’s contribution to society is enormous, helping people back to work, reducing dependency and ill health and having a major impact on the environment, the job market and the economy. Moreover, the NHS is able to work to greatest effect when other services and other parts of society are functioning well. Its particular contribution is to ensure that society is health enhancing and healthy in every sense. Its aims should therefore also embrace the idea of a healthy society.
Finally, the whole world is now interdependent in health terms. We are vulnerable to weaknesses in the health systems of other countries as we saw with SARS and H1N1 which were incubated far away but threatened us along with the rest of the world. Health workers trained in other countries have benefited the NHS as have treatments, drugs and knowledge developed elsewhere. Climate change, nuclear pollution and the health effects of migration affect us all. Health and healthcare are globalising as fast as any other industry or part of society. The NHS has a role to play, too, in sustaining health worldwide.
Taken together these ideas suggest that the NHS should use its expertise in health and healthcare to further the shared aim to:
– enable people to live independently in a way they have reason to value
– support the development of a healthy society
– contribute to the health of an interdependent world
This re-definition is very important because it shows how the NHS needs to adapt for the future. The greatest users of the NHS – at the greatest cost – are the thousands of people with long term conditions who need care over many years to help them look after themselves and manage their intermittent crises. The NHS needs to become much more integrated into other local services, to work with volunteers, carers, family, friends and partners to provide support and enable them to live a life they have reason to value.
*I have adapted this from Amartya Sen’s discussion of people having “the freedom to live a life they have reason to value” in Development as Freedom (OUP, 1999).
Nigel Crisp is an independent Crossbench member of the House of Lords. He was Chief Executive of the NHS and Permanent Secretary of the Department of Health from 2000 to 2006. He is the author of 24 Hours to Save the NHS – the Chief Executive’s account of reform 2000 to 2006.