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“2020health is an important and thoughtful contributor to the health debate”

Dr Sarah Wollaston MP, Chairman, Health Select Committee


The Guardian Julia Manning keeps her finger on the pulse of the NHS

The former Tory candidate for Bristol East has swapped party politics for a thinktank to champion a new health agenda.


With the NHS one of the key political battlegrounds in the runup to the general election it might be expected that someone who once ran for the Conservatives would feel obliged to defend the government’s record. Not Julia Manning. The one-time Tory Bristol East candidate and now chief executive of the thinktank 2020health, thinks all main parties need to up their game.

“Most [politicians] are saying the right words. They are talking about integration [with social care], they’re talking about public health, but there’s no vision for what the NHS might look like or what decisions we need to make to get to a service that is fit for the next 10 or 20 years. I’m sorry to sound really negative, but no one is talking about the fundamental issues we face and what the tough decisions are going to be.”

An optician by profession, she stresses that her activities in the political arena have been driven by personal and professional motivations including working with vulnerable people in private practice. As someone who lacks a history of being party-political she has little time for ideological agendas or outlandish health proposals from the right or elsewhere. On charges for GP visits, Manning is categorical: “Charging for appointments would have a catastrophic effect on inequalities.” As for the recent suggestion that benefits for obese people could be cut if they are unable to work, Manning insists that it’s not just wrong and unworkable, but is symptomatic of a lack of political will to address what is a serious and rising health issue.

“There has to be a whole raft of actions taken because we live in such an obesogenic environment where there seems to have been no thought given to the repercussions of every other shop being a fast food outlet. The problem is well known. There is no single solution. Do we not realise how serious this problem is? So simply to come in and penalise people who haven’t been given the support either personally or through our environmental planning? We [at 2020health] think it’s unfair.” Policies that target individuals, such as people who are overweight, instead of taking “a more strategic” approach to health and wellbeing, are “very trivial, very blaming and very unproductive,” she concludes.

Obesity is one of a raft of health issues along with mental illness and ailments related to an ageing population that are increasing pressure on the health service and Manning wants to see greater focus on all of them. These shifting strains on health and social care budgets, coupled with austerity cuts, are part of the reason why her thinktank has just launched its own manifesto, Making Health Personal and is today publishing a new report on mental health services and depression, Whole in One. As someone who lives with mental health problems (she was first diagnosed with clinical depression when she was 24) Manning’s first-hand experience of services and of how mental illness is perceived is a catalyst for her work, she says.

“I know how bad [mental illness] is. I know how devastating it is.” The latest report presents a broad indictment of a system that Manning argues has consistently relegated mental health conditions as secondary to physical health when they should be given equal status.

Despite recent overtures from politicians across the spectrum promoting parity of care and “a clear momentum” towards reducing stigma, she says there has been only limited progress on the ground in terms of parity and that priorities remain skewed. “There are fundamentally some commitments that we need to make. This is an area that requires more funding, especially in early intervention. That’s absolutely critical.”

Against a backdrop where “two-thirds to three-quarters of people with depression go untreated”, according to the report, it advocates a number of changes, including the way medicines are approved by the NHS for treatment of mental disorders and better training for GPs. It also points to the shortcomings of the flagship talking therapies initiative IAPT (improving access to psychological therapies), including large variations in funding and access around the country.

“We wanted to make this report strong because we do think mental health is an area of significant neglect,” Manning explains. One area that she says is especially worrying is Child and Adult Mental Health Services (Camhs). “I mean, we have a crisis. It pops up every so often but the mental health crisis among teenagers? I can’t put it strongly enough. Quite honestly in some London boroughs you have to be at risk of death before you get referred to Camhs or social services.”

On the broader health agenda the 2020health manifesto stresses the need for early intervention and empowering and educating people about healthier living. However, Manning insists it is not an attempt to shift responsibility from professionals to individuals. When it comes to the challenges facing the health service, including what to fund and how, politicians will need to consider ideas that make the most of existing resources as well as thinking where cash will come from in the future, she contends.

The content of the manifesto reflects this view by mixing policy objectives such as emphasising early intervention, with practical “incremental” suggestions like harnessing digital technologies to connect patients at home directly to professionals in order to reduce home visits. One proposal suggests placing a head of wellbeing in all schools to work across issues from nutrition to mental health. Another calls for a national service guarantee so that “no matter where you live you will know what you are eligible for”, says Manning, thereby tackling head-on the enduring postcode lottery many health service users experience.

She cites Labour’s four-hour waiting time for A&E and the coalition’s policy of “localism” as being major examples of where targets and upheavals in the NHS have failed patients.

“The way localism was originally sold was not what you would get but how it would be delivered so professionals would have the freedom to deliver things as they thought would be best for their local populations. But what’s happened is an increasing postcode lottery around what you can get. We see that as incredibly unfair and inequitable – and it continues to happen without anyone saying, ‘hang on a minute, this isn’t what we envisaged’.” When it comes to the announcement in February by the coalition that £6bn of health budgets are to be devolved to Greater Manchester councils, she concludes: “Changing the way you channel the money isn’t going to raise more funding.”

Manning believes that politicians should “leave the NHS alone because there are enough people in it who want to improve care” but she welcomed the introduction under New Labour of primary care trusts (PCTs) because they gave professionals such as pharmacists and opticians opportunities to evaluate and feed into local service provision, she says.

Manning is evidently driven by her experience working in the NHS but also in private practice where her work as a community optician took her into people’s homes and taught her how important it was that everyone had access to high-quality healthcare. The more she learned about how the NHS worked within communities such as her own in south-east London with high levels of deprivation, the more she wanted to help shape it.

“It was really fundamental. It wasn’t just that I saw the economic case for helping people … the group of people I ended up working with are the most needy. They’re out of sight and out of mind. It sounds stupid but it was really [about] that personal experience,” she adds. “It just brought the realisation home that if you weren’t involved in the capital ‘P’ politics then you were just a bystander.”

She explains that she “learned a great deal” from running for parliament in 2005, saying that she chose the Tories not through any long-standing loyalty (she supported Blair in 1997) but because in the early 2000s she thought Labour had squandered its mandate while the Conservatives “were doing a huge amount to address local issues around poverty and deprivation”.

Manning says if a winnable parliamentary seat had come up she may have considered running again but the diagnosis of one of her children with a chronic condition led her to reconsider. That was when setting up a thinktank seemed like a more manageable option.

The one time Manning sounds like a politician is when asked about the ethics of having a pharmaceutical company sponsor a report (in the case of Whole in One, the Danish firm, Lundbeck) when 2020health claims it is independent. She responds that no editorial control is ever given to sponsors or funding partners. She shies away from addressing directly the issue of private companies playing a bigger role in the NHS, but says that as with the debates around devolution and restructuring it can be a distraction from the bigger task of figuring out what kind of NHS is needed. “What I feel is really missing is a frank debate about the issues... but also the choices that should be being made about what we prioritise.”

As for the immediate future, Manning says the hope is that whoever is in power come May will act on the recommendations in the depression report. “Implementing them would be steps in the right direction.”

2020health Report Whole in One: Achieving equality of status, access and resources for people with depression

Whole in One: Achieving equality of status, access and resources for people with depression

This report focuses on depression in adults, with particular emphasis on access to NHS services and treatment, the funding of services, depression in the workplace, and the role of the National Institute for Health and Care Excellence (NICE). read on Whole in One: Achieving equality of status, access and resources for people with depression