I suspect that my opinions on the NHS differ from most other people in the Country. I don’t believe that we have a very good National Health Service but I do believe we have a world beating National Illness Service. When the chips are down the NHS looks after you really well. My Mum is currently seriously ill in the Countess of Chester Hospital and I cannot fault the care and attention that she is getting and the work and attitude of the staff. If you are ill or in an accident the UK is the place to be because here we are really looked after when we need to be.
But let me recap two conversations with you that I have had with GPs lately as we have pondered the NHSA reforms during the pause.
The first related to a case where a GP had been prescribing drugs to a patient for some years because of chronic lung problems; where that patient as having to go into hospital and would then need considerable care thereafter. The cost of the hospital would be about £3,000 per week plus all the cost of the drugs over the years. The cost of a new damp proof course and draught proofing in that lady’s house would have been £3,000. Spend that and she wouldn’t have been ill!
The second related to a case of severe but not chronic depression. The reason for this was a continual round of money and benefit worries. The GP would like to have prescribed a visit(s) to a money or welfare counsellor instead of drugs. The welfare adviser would have been cheaper and more effective but the service was not available.
Some of the GPs that I am now working with have an ambition to use the reforms in the Bill to do things fundamentally differently. They feel confined by the Health Service and recognise absolutely the need to bring holistic solutions to bear on the needs of the patients they care for. Some of them have expressed that as, ‘wishing to be the front door to the public sector and not just the health sector for their patients’.
Now we all know that not all GPs are as progressive in their thoughts as this. Many like the rarefied and sanctified atmosphere of the consulting room and medical role. But the tide is turning and more GPs and indeed other parts of the medical profession are looking for total people, total place solutions.
Currently we are debating how much money is being transferred to councils when public health rejoins us. That is a useful first debate but only a first debate. We need to move rapidly to a consideration of a massive transfer from clinical services to prevention activity. The prime role of the public sector should not be to cure but to prevent illness and harm, in the first place.
As a society we need to have a major debate about two things:
- How much we can reasonably afford to spend through taxation especially as drugs are getting more expensive and people are living longer.
- How much we should spend on prevention rather than cure.
In my view those debates are unlikely to happen for two reasons
- We have all been weaned on TV programmes such as Dr Finlay and Dr Kildare which makes us assume that health is a doctor/hospital matter
- Politicians are more keen on using the NHS debate as an ideological background for electoral purposes than as a place to shape up to big issues that will not go away and where they will need to provide community leadership to take the public to new places and new ideas.
We know that stopping people smoking saves a fortune in health care albeit 20 years later. We know that people are getting ill because of where and how they live. Some of these factors are a matter of choice and cannot be changed but many are either a matter of choice or need a change in public policy and public spending.
Public Health activity is an investment which can save a fortune in prevention which can either be used to meet the new challenges or could be used in other associated front line services. This seems obvious but the debate we are having on it is dreadful.