The House Article | The DHSC alone cannot fix our health and care crisis

NHS hospital ward (Alamy)

4 min read1 hr

His decision to seek a cross-party solution recognises a simple truth: Britain’s biggest challenges cannot be solved by one department, or one government, acting alone.

Health more broadly deserves the same approach. Now is the time to establish a sub-Cabinet-level Health and Care Equity Taskforce or Board, reporting directly to the Prime Minister. It should bring together ministers from Health, Housing, Education, Work and Pensions, the Treasury and local government, alongside public health experts, NHS leaders, social care, business and the voluntary sector.

Over more than three decades as an NHS consultant, I saw firsthand that the Department of Health and Social Care cannot make Britain healthier on its own.

As a consultant gynaecologist and specialist in reproductive medicine, I treated the consequences of inequality rather than its causes. Women with years of untreated symptoms because they could not get appointments. Couples denied fertility treatment because of their postcode. Poverty, poor housing, insecure employment, stress and poor nutrition appeared disguised as medical conditions.

I could treat symptoms and diseases, but I could not deliver warm homes, secure incomes or good educations.

As vice-chair of the British Red Cross, I saw the same pattern. In emergencies or supporting vulnerable communities, the people facing the greatest health challenges were often those already struggling with poverty or loneliness. Their problems did not fit neatly into government departmental boundaries, yet our solutions still do – that is our fundamental mistake.

England now has a nearly 20-year gap in healthy life expectancy between the most deprived and most affluent communities. That gap is not created by hospitals but by one’s quality of life. Around 80 per cent of health outcomes are determined by the wider social determinants of health: where we are born, grow up, learn, work, live and age.

If we continue asking the NHS to solve problems that begin decades before a patient enters a hospital, we will continue to overload the health service while failing to improve the nation’s health. The language of “fixing the NHS” is too narrow. We must also fix the conditions that make people ill in the first place.

Nor can we reform social care in isolation. Health and social care are inseparable, and both are shaped by policies reaching far beyond them.

Every major department influences the nation’s health. The Treasury determines investment. Housing affects respiratory disease and mental health. Education shapes lifelong opportunity. Work and Pensions influences financial security and employment. Transport affects access to healthcare. The Home Office influences community safety. Health is not produced by the Department of Health and Social Care alone; it is produced by government as a whole.

The economic case is just as powerful as the moral one. If the North of England had the same health outcomes as the rest of the country, it could add £18.4bn to our economy every year.

Poor health reduces productivity, increases welfare dependency, constrains economic growth and places ever greater pressure on public finances. Investing in healthier communities is not merely a social policy; it is economic imperative. A healthier population is one of Britain’s greatest untapped growth opportunities.

Andy Burnham has shown leadership by recognising that adult social care requires cross-party and cross-government thinking. I hope he will now take the next step and establish a central Health Equity Taskforce. Its purpose should be ambitious: to ensure that every major departmental policy is judged not only by its economic impact but by its impact on the nation’s health.

For decades, we have treated health as the responsibility of one department. That approach has failed.

If we truly want an NHS fit for the future, and a country fit for the future too, we must stop thinking of health as something delivered in hospitals and start recognising where it is really created: in our homes, our schools, our workplaces and our communities.

That is how we will reduce inequality, build a stronger economy and create a healthier Britain.

Baroness Nargund is a Labour peer