What the UK general election means for people who use health and care services (all of us!)

An often used expression in healthcare goes: “people might know what they want from a doctor, but they don’t necessarily know what they need.” This sentiment is illustrative of the medical paternalism that still runs through healthcare services and affects decisions ranging from severe access restrictions in mental health services, to efforts to divert people away from the emergency department.

Patient advocates naturally push against such beliefs, pointing out that only the person with the health problem fully understands the impact that a condition or disability has on them.

The recent UK general election, and the preceding campaign, should have been an opportunity to clarify what we as patients, and as a society collectively, want from our healthcare services, and what we are entitled to expect. It should have set out clearly—to the NHS, to those who work in it, and those who use it—what resources will be available, and what standards can therefore be delivered and should be upheld. I don’t think I am alone, if I conclude that we have not achieved this clarity. We have heard a set of retail policies: more hospitals, more doctors, more community nurses, more appointments, more access. But we have not had an honest debate about any trade-offs, particularly in light of continually restricted financial settlements.

Now that we know we have a Labour Government, we do however know that our new political leaders say it will take 10 years to put the NHS back together again, to move care closer to home, to reinstate access to acute care, and to ensure people can see a GP when they need to. The NHS seems to currently be in a state of perma-crisis: workforce woes, buildings falling down, difficulties reaching a GP in a timely manner, record waits for mental health assessments, let alone the misery that is the failure to adequately resource and reform social care.

Wes Streeting, the new Secretary of State for Health and Social Care, has also indicated that an inclusive process will be set up that brings together a range of different stakeholders and voices. We therefore have a chance to shape more long term thinking, to support and challenge the development of a proper long term plan for NHS reform, and for better health. This could be our opportunity to finally convince long standing paternalists that they need to listen to what we want, because only we know what we need. But—what if it transpires that we want a lot of different things? What if the different things we want are in tension with each other? What if we collectively and individually fail to own the trade-offs and hard decisions that are long overdue about how resources need to be allocated and organised within the health and social care system?

We cannot spend unlimited resources on the health system. As citizens, parents, commuters, and renters we also want other things: bearable tax rates, good schools, punctual trains, affordable housing. Given what we can spend on health is limited, those who understand the impact of interventions all agree that you get the most “bang for your buck” if you go upstream: stop people smoking, help them quit, support them to look after their health well or to manage their illness effectively, intervene early when people indicate they aren’t coping, and so on.

This is where you buy yourself the most health for your money, but it is not on the whole what people say they would like when you ask them simple questions about the NHS. Instead, they tend to want the ambulance to come quickly, and the referral to a hospital doctor to lead to a timely appointment. This is the notion of the NHS as a safety net. You never know when you might need it, but you want it to be there. And we would all agree that this safety net is now too threadbare and has massive holes in some places. But having a safety net for when people fall doesn’t mean we should have no interest in the things that trip them up in the first place.

This is the conversation we now need to have, urgently, so we can build a health system for the future, with our new leaders who—at least briefly—have a mandate to act with courage and conviction. What do we need to do to ensure people understand what they can do to look after their own health and wellbeing, and ensure that they are supported to take this action? What will reduce the likelihood of people falling over and needing the NHS safety net of acute care?

How can we harness the power of our economy, of creating good jobs, of building sustainable houses, and supporting thriving communities? How can we encourage the use of peer support, education, and technology, to ensure more of us move through our lives with confidence, with health literacy, and with a steadying hand from our community if we have a wobble? Only once we have become serious about the things that keep people well—good work, good homes, good education, resilient communities—can we make sure that those of us who tumble and fall can consistently be caught with kindness, compassion, and expert help. This does not of course mean that poor health can’t affect any of us, at any time. The safety net is important for precisely this reason, but we cannot confuse it with the job of health creation.

We need to get ready to have this honest debate about the limits of the safety net, and the need for health in all policies. We need an acknowledgment from the medical system that it cannot “fix” many of us, but that instead it needs to work alongside us to figure out how to live well with mental ill health, pain, and even life limiting illnesses. We need an acknowledgment from politicians that no health system can afford all the things that are medically possible for everyone. The only fair and humane way of sharing healthcare resources is to focus on where it makes the biggest difference, not where it includes the shiniest new hospitals, scanners, or drugs. As citizens and patients, we must acknowledge that medicine will not be able to extend our lives endlessly: that our bodies are frail, and that we need to support and challenge ourselves and each other to do more of the things that actually make for a good life—in illness and in health.