Health is made at home, hospitals are for repairs

November 13, 2020   By Lord Nigel Crisp, former Chief Executive of the English NHS

Health care is so much more about what happens in hospitals, writes the former Chief Executive of the English NHS. Instead, it can thrive with the help of ‘health creators’ – ordinary people creating healthier communities. And it’s time our bigger institutions took note.

Most of us think of the NHS when health is mentioned. And of health professionals, nurses and doctors and others. We may also think about government policies. But the NHS, professionals and the government can’t do everything by themselves. And as the psychologist Penny Jones asked, when did we decide to outsource our health entirely to the professionals and government?

Health professionals and the NHS have profoundly important roles in every aspect of treatment and care and in offering advice and support to each of us and to government. We are fortunate to have vast resources of health knowledge and skills in this country. Government also has vital roles in policy, funding, protecting the public and incentivising health improvements. But the NHS and government can’t by themselves deal with many of today’s biggest health problems such as addictions, stress, loneliness and obesity. They can do the repairs, but they can’t tackle the causes by themselves.

But there are people all over the country who are not part of the formal health services who are addressing these causes. The ‘health creators’ as I call them. People like the policeman in Cornwall who was fed up with chasing young people for minor offences and worked with them to create a dance club which now – 14 years on – is run by the young people. It has improved mental and physical health and well-being locally and reduced crime. Or the group of women in Yorkshire who started growing vegetables in public spaces, promoting communities and greater knowledge of food, and who have inspired 150 other groups around the country. And the woman in Skelmersdale who set up a community sewing business providing local employment and supporting lonely older women.

These health creators are doing something different – taking control for themselves and their communities.

This is not just about self-help, each of us looking after ourselves. Nor is it about professionals telling us what to do by prescribing activities – social prescribing – or about co-production where health professionals work with their patients. These are all important and valuable recent developments, but they maintain the power of the professional and are business as usual.

These health creators are doing something different – taking control for themselves and their communities. Acting for their own reasons, seeing a problem and dealing with it. And they tend to see health in a very rounded and holistic way and as directly connected with other desirable goals such as education, social justice and strengthening communities.

They are creating health by which I mean creating the conditions for people to be healthy and helping them to be so. It what parents do. And good teachers do and good schools, good communities and good employers – helping create confident, capable, resilient and healthy individuals.

I tell some of their stories in my new book Health is made at home, hospitals are for repairs. The title comes from Professor Francis Omaswa who used to run the Ugandan health service – a country where, like many in Africa, they know about the role of communities in health.

The book identifies 10 key lessons we can learn from the health creators: the importance of building relationships, for example, and learning by doing and the vital role that taking control plays and, of course, the value of building communities. The health of individuals is intimately connected with the health of communities, of society as a whole and of the planet.

The health of individuals is intimately connected with the health of communities, of society as a whole and of the planet.

Health is made at home also describes 10 policies which government needs to adopt – ranging from education and housing to planetary health – in order to help create health for the population and support the health creators. Sir Michael Marmot has led the way globally in showing how social structures and inequalities affect our health and empathised how important government policy in these and other areas can be in countering these negative effects. And the Covid pandemic has shown us very starkly how different parts of the population have been affected differently – with people from black, Asian and minority ethnic groups particularly and many people losing their livelihoods and employment. 

I argue in the book that we need to think about health differently and recognise that health creation plays an important role alongside health services and the prevention of disease. It is time to being it into focus, celebrate and support the health creators and recognise that health is made at home and in the school, the workplace and the community …

This approach fits perfectly with New Local’s community paradigm and I look forward to seeing how they incorporate health – and particularly health creation – into their thinking and policy in the future. There is an extraordinary wealth of examples to build on.


Nigel Crisp is an independent crossbench member of the House of Lords and was Chief Executive of the English NHS and Permanent Secretary of the UK Department of Health from 2000 to 2006. He has since worked extensively on health in Africa.

His latest book Health is made at home, hospitals are for repairs is published by Salus and available at www.healthismadeathome.uk The website also contains recordings of a series of webinars in which health creators discuss their work.