Big Issue Vendor

The NHS can’t do everything. We need a homegrown approach to health

Loneliness, stress, poverty, addiction. The health service does the repairs – but post-Covid the prevention part is down to us, says former NHS chief Nigel Crisp
DTJK2W DTJK2W Volunteers at a Incredible Edible Garden plot. Todmordon, Yorkshire.

The NHS has been fighting for our lives for the last few weeks and months. Throwing all its resources at the pandemic. Millions of health and care workers have been magnificent, rising to the occasion with bravery and skill. They have demonstrated, among other things, that we must support and resource them better for the future.

Government has also had a crucial role to play: providing leadership and direction, introducing emergency legislation, and supporting the NHS and the economy. There will be many lessons to learn from this experience about preparedness and the role of government in future health emergencies.

And it’s been up to us, the general public, how far and how fast the virus spreads. Our behaviour has mattered – and still does. Millions have volunteered to help, kept community and voluntary activity going, or simply looked after our neighbours. Millions more have kept the vital non-health emergency and other services running in agriculture, retail, delivery, power, transport, finance, rubbish collection and so much more.

The NHS can’t deal by itself with many of today’s major health problems such as loneliness, stress, obesity, poverty and addictions

The NHS, government and the public have all had our part to play.

The future looks very tough. The economic situation is bleak and the NHS has to deal with a massive backlog of treatments. The legacy of the virus will be with us for years to come. And we can anticipate further waves and many more local if not national lockdowns.

The pandemic has shone a light on some of the hidden truths about our society. The migrant workers who do so many of the lowest-paid and insecure jobs, the millions on zero-hour contracts with no support, the homeless, the poverty and inequality, and the way different ethnic groups have been affected. We may all have been in this together but it has impacted us very differently. And, it is making us confront the uncomfortable reality that the old normal was bad for many people.


If you pay for the magazine you should always take it. Vendors are working for a hand up, not a handout.

Providing the conditions in which people can be healthy – it’s what parents do for their children. And what a good teacher does. And a good employer

The NHS and government will be fully occupied dealing with all this, but what’s our part in the future?

Looking forward, there will continue to be a vital role for us all in health because the NHS can’t deal by itself with many of today’s major health problems such as loneliness, stress, obesity, poverty and addictions. It can only really react, doing the repairs but not addressing the underlying causes.

There are people all over the country who are tackling these causes in their homes, workplaces and communities. The leaders and pioneers. People like the policeman in Cornwall who was fed up with chasing children for vandalism and petty crimes so he worked with them to set up a dance club. It is still going 14 years later and has improved mental and physical health as well as reducing crime in the area. The women in Yorkshire who started growing vegetables in public spaces and branched out into cookery classes and community activities and started Incredible Edible, a movement that now has 150 groups countrywide. And there have been community groups springing up all over the country to support their neighbours during the pandemic.

Health and wellbeing are about life and freedom, being all that we can be, and living life to the full

They and many more are dealing with the problems they see in their organisations and communities. Not waiting for government or health professionals to tell them what to do. Breaking new ground, taking the initiative and leading.

These leaders and pioneers are creating health in their communities – providing the conditions in which people can be healthy and helping them to be so. It’s what parents do for their children. And what a good teacher does. And a good employer. All of them exercising a profound and positive influence and helping create resilient, confident, capable and healthy individuals.

They are not just preventing disease but creating health. Health and wellbeing are about life and freedom, being all that we can be, and living life to the full. They are about our relationships, how we live, and what happens to us at work and at school. And about confidence and being in control, and the quality of our lives.

We need more health creators as we recover from the pandemic. We also need better government policies which will help create health. We need, for example, increased vocational education opportunities for children, reform of the Ofsted inspection so that it focuses on the real substance of education and not on narrow test results, and reductions in the number of children permanently excluded from school. We also need a Healthy Homes Act to guarantee minimum standards of housing and to take the opportunity created by Covid – as The Big Issues argues – to tackle homelessness once and for all. And we need to reform the current zero-hours and gig economy and offer all workers protection and support.

As an African health leader told me: “Health is made at home, hospitals are for repairs”… and it’s made at home, in schools, the workplace, communities and families.

Nigel Crisp is a crossbench member of the House of Lords and was chief executive of the NHS from 2000 to 2006. His latest book, Health Is Made at Home, Hospitals Are For Repairs is out now (£9.99)

Image: Alamy