Prevention – the real challenge in those #secretnhsplans

Man limbering up for exercise. Prevention

Prevention is better than cure. So why isn’t more being done to prevent people from suffering illness and disability in later years? Our deputy director of public health, Sam Crowe, explains more about those ‘secret NHS plans’ and issues a rallying call for people and organisations to do more.

Prevention illustrated by boy on swing

Prevention can be creating more open spaces for children to play and socialise.

 

By Sam Crowe

If you’ve seen any news about healthcare recently, you may have heard about mysterious plans afoot in the NHS.

Some commentators are portraying NHS sustainability and transformation plans (STPs) as #secretnhsplans to cut hospital services and privatise the surviving services. But the truth is far less sensational.

There’s a more mundane story behind STPs. This is that, unless the NHS and partners change significantly the way that they work, focusing more on prevention, the NHS will be unaffordable.

Money problems

Escalating demand for services is fuelling the financial cliff edge facing the NHS. This includes routine operations, GP appointments and attendances to accident and emergency departments.

In many parts of the country the cliff edge is not just ‘at some point in the future’ but right under our feet.

There needs to be a serious scaling up of efforts to prevent common diseases like diabetes and cancer. Otherwise, more of the NHS budget will be spent treating and dealing with the consequences of what are often preventable conditions.

Recently, our senior analyst wrote about the extraordinary rise in hospital admissions in Dorset due to obesity. This is up from 1,500 a year to more than 10,000 a year in just half a decade.

Dietary risks are now the leading cause of early death and years spent living with a disabling illness (DALYs, or disability-adjusted life years) for people in South West England. This is more than tobacco and physical activity.

It is also possible that poor diet and excess weight are also contributing to the rising cardiovascular disease death rates we are seeing.

Burden of disease graphic

Chart showing the biggest causes of disease

Prevention plans

In Dorset, the NHS and councils working together have recognised that preventing illness must lie at the heart of any plan that attempts to put the NHS on a more sustainable footing.

In this year’s Director of Public Health Annual Report, Dr David Phillips sets out the start of a prevention strategy for Dorset, as part of the STP.

He talks about how scaling up prevention efforts, focusing on four risks (diet, physical activity, smoking and alcohol) would lessen the demands on the NHS over time. We would particularly see the impact of this in hospitals.

Current NHS services are good at helping people to live longer, but not necessarily in good health. This can lead to over-investigation and over-treatment for common, age-related chronic conditions, especially towards the end of life.

But let’s look at the opposite. Where the NHS, wherever possible, takes a more prevention-oriented approach. This should lead to more people living life free from chronic diseases, like diabetes and coronary heart disease, for longer. That would put less strain on services and mean that people enjoy a better quality of life in their later years.

A challenge for all

The report is a call to action for individuals, organisations and places. It challenges everyone to step up and recognise what more they can do to work together to support people to live healthier lives.

So, I’m sorry that the truth is not as exciting as #secretnhsplans.

Prevention may not make such good headline material. But the consequences of not acting almost certainly will.

Sam Crowe is deputy director of Public Health Dorset

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