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Editor's Choice

A plan for unhealthy growth

BMJ 2022; 378 doi: (Published 28 September 2022) Cite this as: BMJ 2022;378:o2336
  1. Juliet Dobson, managing editor
  1. The BMJ
  1. jdobson{at}
    Follow Juliet on Twitter @Juliet_hd

The UK government’s plans for the NHS and the economy, unveiled last week, don’t bode well for the health or the wealth of the nation. The plans illustrate the government’s failure to grasp the link between poverty and poor health outcomes and reveal a complete disregard for people’s health and wellbeing.

The fiscal measures announced by the chancellor of the exchequer on Friday 23 September will increase financial and social inequalities and, writes Danny Dorling, risk making England the most unequal country in Europe (doi:10.1136/bmj.o2318).1 They will disproportionately benefit the richest people and will make poorer families even poorer. The “mini-budget” provides no answers to the cost of living crisis, which is already having a detrimental effect on people’s health and is expected to get much worse this winter.

Even before these measures were announced, paediatricians and experts warned that increasing numbers of families, children, and older people are living in poverty, facing a choice between food and heat, resulting in a humanitarian crisis (doi:10.1136/bmj.o2286, doi:10.1136/bmj.o2129).23 Not only will increasing levels of poverty and wider health inequalities put a greater strain on the NHS, but the government’s plans for the NHS do nothing to tackle the current crisis in health and social care (doi:10.1136/bmj.o2339).45

Thérèse Coffey, the new secretary of state for health and social care for England, tried to position herself as a champion of patients with Our Plan for Patients (doi:10.1136/bmj.o2299).6 But the plan has been widely dismissed. David Oliver describes it as “inadequate” (doi:10.1136/bmj.o2296),7 Richard Vize says it offers “nothing of substance” (doi:10.1136/bmj.o2304),8 and GPs’ leaders say it will make “no tangible difference” to patients (doi:10.1136/bmj.o2299).6 It provides no new money, is missing detail, and completely lacks the workforce plan that is so desperately needed to improve recruitment, retention, and morale, write Hugh Alderwick and Helen Salisbury (doi:10.1136/bmj.o2332, doi:10.1136/bmj.o2315).910

The impact of understaffing and lack of investment in workforce is evident in community services, where a shortage of health visitors has been worsened by the covid pandemic and is having a negative effect on women’s and children’s health (doi:10.1136/bmj.o2189).11 The most vulnerable children and families are the most affected, increasing already existing inequalities. This lack of investment is a false economy, as it puts children at a disadvantage from the very start of their lives but adds to demand for health services later in life.

A shortage of skilled staff was also an obstacle in scaling up laboratory testing during the covid pandemic and continues to be a key weakness in the UK’s ongoing pandemic preparedness (doi:10.1136/bmj-2022-072467).12 And where are the UK’s plans for dealing with covid this winter? Cases are once again on the rise, but the NHS plans barely mention covid, unlike our European neighbours, who—say Martin McKee and Samantha Field—have “comprehensive and forward thinking” plans in place (doi:10.1136/bmj.o2331).13 This lack of planning to prepare for another covid wave overlooks, once again, the cost of poor health to the economy, be that from disruption and staff absences or long term sickness as a result of long covid (doi:10.1136/bmj-2022-072117, doi:10.1136/bmj.o2287, doi:10.1136/bmj.o2188).141516

The UK government’s plans also fail to tackle the climate crisis; instead, proposals for investment zones have been called an “attack on nature” ( A ban on fracking was lifted despite no change in the evidence about the harms of fracking to human and planetary health (doi:10.1136/bmj.k2397).18 These myopic policies defy humanity’s unshakable dependence on a healthy planet, without which there can be no health and no wealth (doi:10.1136/bmj.o2326).19

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