Another new era of public health
39 Victoria Street
“Humphrey. It’s good to have you back.”
“Thank you, Minister.”
“I spent some of last weekend mulling through the press release we issued last Friday. Apparently our new Office for Health Improvement and Disparities (OHID) will give us all ‘live longer, healthier and happier lives’.”
“It is the dawn of a new era, Minister.”
“According to the press release, as Public Health England is no more, ‘the new UK Health Security Agency will have a laser-like focus on health protection, while OHID will improve health and tackle disparities in health outcomes across the country.’ If OHID has levelled us all up to full health, what will be left for the new Agency to be training its laser-like focus on? It sounds like the Bond movie ‘No time to die’.”
“You cannot have too much of a good thing, Minister. We have an ever-increasing population to care for.”
“It’s certainly inspiring reading though I’m not sure why we are for disparities. I never knew we had such powers. The key seems to be stopping people from smoking, drinking, partying and eating the sort of food they enjoy.”
“That is basically the plan, Minister. It appears that people, especially deprived people, cannot take care of themselves; they need our help.”
“I get that, Humphrey, but we also claim it will make them happier. How does depriving people of all that they enjoy make them happier? Indeed, you could say it makes them even more deprived.”
“A neat play on words, if I may say so, Minister. We are removing inequalities. The deprived members of our society eat, drink and smoke more than the more affluent. If we can reduce their consumption of things which we disapprove of, they will be more like us and better off too.”
“Do they want to be more like us?”
“Possibly not, but they will live longer.”
“Or it will just seem longer.”
”Rather an old joke, Minister.”
“Sorry about that but my point remains: is depriving the deprived of the things they enjoy, a recipe for their happiness?”
“What will make them happy is recognising that they have a government that knows what is best for them.”
“That is not helped, Humphrey, by our claiming more than we can deliver. Only last Saturday, we put out a press release saying that part of the extra £70bn we have just given to the NHS will be used for 40 community diagnostic centres which will all be closer to where people live than the 223 hospital trusts to which they would otherwise go. That is patently nonsense.”
“True but it is an important part of our plan to stop sick people visiting GPs or hospitals. That is what the new OHID is all about. The best way of keeping the costs of the NHS down is to stop people bothering them.”
“That’s all very well, Humphrey, but I am looking for just a bit of integrity in what we say. The two biggest reasons for shorter life expectancy are gender, women live longer on average, and ethnicity. In England, the Chinese live longest, followed by white British, with African and Asian ethnicities trailing some way behind. The non-white population has doubled so longevity has declined. QED.”
“We take a pragmatic view of the problem and assess disparity by where people live. It is quite clear that people in more deprived areas suffer worse health than those in less deprived areas.”
“So why don’t we just move people from the former to the latter. No problem.”
“Well, we are trying to build many homes in the more affluent areas but, unfortunately, they all have MPs from your party, Minister, and they object vehemently. You may not have read the paper on levelling up health and reducing disparities that Public Health England put four years ago. To summarise the action we were then initiating, we would:
‘A. Give every child the best start in life
B. Enable all children, young people and adults to maximise their capabilities and have control over their lives
C. Create fair employment and good work for all
D. Ensure healthy standard of living for all
E. Create and develop healthy and sustainable places and communities
F. Strengthen the role and impact of ill health prevention.’”
“And how much of that did we achieve, Humphrey?”
“Absolutely none, Minister. It has probably got worse but we can blame COVID for that.”
“Humphrey, that is what I am grumbling about. The claims were wholly unrealistic. The public would like to see achievable, measurable goals and regular quantified reporting on progress toward those goals, not some ludicrous aspirations that cannot be delivered. The idea that some quango of the Department of Health and Social Care is going to achieve ‘fair employment and good work for all’ is simply absurd.”
“Minister, may I remind you that it is our job to create policy – not to do anything about it? Are you against fair employment and good work for all?”
“Well, no.”
“There you are. But I do agree we need measurement to have some idea of whether we are making progress or not and we need objectives for which we are plausibly responsible. Are we talking about total life expectancy or healthy life expectancy, i.e. not needing care, or disabilities-free life expectancy?”
“You tell me, Humphrey. What people obviously want are happy, healthy care-free lives but if we target that, people will say we don’t give a damn about people needing care or with disabilities.”
“At the end of the day, Minister, it is all a question of money: the poor are deprived health-wise and the affluent are not. Poor health therefore is a matter for the Treasury, not for us.”
“So we can close OHID down and save the taxpayer some money?”
“Oh no, Minister, we have to look as though we are doing something. In reality, our efforts will change nothing and that will allow us to announce a new era of public health in five years’ time.”
“Humphrey, may I have a couple of those tablets you have in your top right-hand drawer?”