Boilers on prescription might not sound like an obvious link to radical devolution. But it’s a strategy that GPs working with housing provider Gentoo implemented in Sunderland in 2016. And it worked.
The scheme allowed GPs to “prescribe” new, efficient boilers and home insulation to patients suffering respiratory conditions and living in damp, cold homes. It cost the local NHS Clinical Commissioning Group £5,000 per home. But the savings and health benefits were remarkable. Residents saved around £125 annually on their fuel bills, removing some financial stress. Their bedrooms were 3 degrees warmer. GP appointments, which cost the NHS £100 each, fell by 60% and emergency hospital admissions – at £2,500 each – dropped by 25%. And, best of all, people were happier.
It’s intuitively obvious that a stitch in time saves nine. In the North East we have some of the best hospitals in the world. Yet we have the lowest life expectancy in England.
Housing, income and transport all determine your health. If your work is insecure and you don’t know how much you’ll earn from week to week, the stress will take a toll on your health. If you can’t get to work or the shops on foot or by public transport, you’ll likely become dependent on your car.
But what’s the link to radical devolution?
Andy Burnham, my counterpart in Manchester, has taken a joined-up approach in tackling homelessness. People who are street homeless typically have very complex needs. His “A Bed Every Night” policy provides people with a safe and stable place to stay, and wrap-around support. The local NHS Trust, the Police and the Probation Services all work together. Yes, this costs money up front – around £11,000 per person. But it results in fewer admissions to A&E, and fewer nights in the police cells. The savings? £24,000 per person.
Manchester can do this, because health and policing are all devolved to their Mayoral Combined Authority. But despite the evidence that pilot schemes like boilers on prescription work, they rarely get implemented at scale.
Our country has seen ever greater fragmentation, outsourcing, and internal markets introduced. Services get contracted out to different firms. They’re only responsible for hitting their immediate targets. There’s no incentive to plan ahead, and no mechanism to recoup the savings if they did. The logic that free market competition will drive down prices doesn’t work with public services. It results in expensive duplication and administrative overheads. We don’t want our public services competing, we want them cooperating.
Public Health England’s latest data shows that three in ten adults are obese. This really matters. Obesity is a risk factor for chronic conditions like type 2 diabetes, stroke and osteoarthritis. Around ten per cent of the annual NHS budget is spent on diabetes-related treatment alone. Childhood obesity is rising too. By 2050, it’s estimated that obesity will cost the UK £49.9 billion per year.
There’s a limit to what can be achieved with more leaflets or taxes on sugary drinks. It needs system change.
I’d like to see a public transport system that’s so cheap and reliable that people leave their cars at home. An extra ten minutes walk each way to work uses enough calories to lose half a stone in a year.
When poor employers pay low wages, they’re shunting the costs to us, the tax payer. Their workers’ health suffers along the way. A Good Work Pledge with a Real Living Wage saves us all money in the long run.
I’ve been lobbying government to adopt this Invest To Save approach for the North of Tyne’s next wave of devolution. Westminster is too remote for effective joined up policies. Rather than central government using our money to patch-up avoidable problems, I want to invest upfront and prevent them. It’s far more cost effective than the false economy of austerity.
Our society needs to start counting the true cost of our polices. Allowing regional governments to invest and improve people’s lives today will save money tomorrow. We’ll be healthier, more productive and happier.
Originally published in the Journal and Evening Chronicle 5.10.20