No matter where you turn, you can’t escape the seventieth birthday of the National Health Service. Yes, there are issues. Some NHS-grown: Gosport, lower cancer survival rates, and the stubborn insistence in using the post for routine appointments.
Others are governmental: medical cannabis and, of course, funding. Institutional rigidity and appeals to that mystical past are everywhere but there is little if any analysis of how life worked before the NHS.
The NHS is our unifying religion. We praise the level of care received with some of the lowest funding. We brush failings under the carpet – that is, if NHS managers have not already done that.
But perhaps its biggest problem is that it remains the NIS – the National Illness Service. It’s brilliant with chronic disease and emergencies – heart attacks, strokes, road incidents and fires. It scores low, however, on prevention – where the private sector is also unimpressive. Prevention is a lot cheaper.
Both private and public health services are good at reshaping bodies, sometimes for cosmetic purposes – tattoo removal, perhaps. But should these bodies have got into this shape?
Christine Hancock, a former general secretary of the Royal College of Nursing, and now running charity C3 Collaborating for Health, is a passionate believer in preventing illness. She cites figures showing that at least two out of three medical crises could be held off by lifestyle changes.
Strip out risk factors such as smoking, alcohol, bad diet (often coupled with lack of exercise) and the root causes of premature death are massively eliminated. You have stopped the main drivers for cardiac problems, diabetes, cancers and many other chronic conditions. Equally importantly, the cost of providing illness services is hugely reduced.
I live in an area with a high level of diabetes. It’s culture-driven to a substantial extent – with a mix of high sugar intake and seeing car ownership as an aspirational good (including driving short distances because “only losers walk or cycle” and “I have an expensive car”). The local council is continually pressured to provide more and more free parking.
The nearest GP surgery has videos in the waiting room to encourage better lifestyles. But who watches them, let alone remembers their message afterwards?
Prevention has one major success. Over the life of the NHS, smoking has fallen from around 80% of the male population to under 20%. But that’s thanks to constant nudging from government – above average tax rises plus the decision to ban smoking just about everywhere indoors.
My local NHS hospital greets arrivals with signs saying smoking is banned both indoors and on the hospital grounds. Yet the smokers congregate under the biggest sign, often in wheelchairs, pushing drips and with recent limb amputations to display.
Despite that, smoking policy has been successful. Compare that with alcohol, more available and cheaper in inflation-adjusted terms than ever. Alcohol drives chronic illness but is also behind so much accident and emergency demand, especially at weekends.
And this is before even obesity. NHS ambulance and other staff now receive training on how to deal with those weighing over 40 stones – nearly three times a typical male rugby player.
Hancock believes in a carrot mainly approach with rewards for good behaviour. In the UK, there is every incentive to eat badly. It’s cheaper, it’s more fun, it satisfies the sugar and salt cravings, and few know that it’s harmful. Taxpayers pick up the tab.
She cites the tie-up between Discovery (Vitality’s South African owners) and South African supermarket group Pick’n’Pay whose website has a nutrition and wellness section with tips on healthy eating. What UK supermarket group has anything similar? Tesco Wellness consists of gadgets and vitamin pills. Sainsbury’s has a range of healthy food under the Be Good to Yourself label and piloted a staff sickness reduction scheme in 2012.
Waitrose does better with a recently introduced plan to have nutrition advice on hand in stores with more health information available to its customers. But wider attempts at labelling food with an easy to understand traffic light scheme seem to have hit the food industry buffers. .
“Many shoppers have the best intentions to be healthier but busy lives get in the way,” says Moira Howie, Nutrition & Health Manager at Waitrose.
But what Discovery did with the Pick’n’Pay group goes much further. It looked at all the supermarket’s food lines – around 10,000 – and picked the 3,000 healthiest. It labelled them as such so everyone can see. Discovery customers get more, however, in the shape of an instant, and meaningful, discount on these products. And non-policy holders get to know about it – items are starred on bills to show they are better for you.
The store benefited by selling the healthy stuff rather than the cheapest rubbish while Discovery spends less in claims.
As Hancock concedes, health insurance is for the better off who are already more likely to engage with healthy lifestyle messages. It’s a socio-economic problem but engagement programmes in the least well off areas do show that poor diet is not always a choice – local shops simply don’t stock anything better.
Evidence from Denmark and the US suggest that little pushes here and nudges there can work. Buildings should make the stairs visible and attractive to prevent lift use – some take it for one floor because the staircase is hidden as an emergency exit. Many buildings now force people onto lifts for “security reasons”. So turn the stairwell into an art gallery with free soft drink dispensers.
Free bus passes for school age kids have the downside that many travel for one or two stops; they don’t walk or cycle.
In the short term, the debate is how does the NHS survive until its 75th, let alone 80th birthday. Longer term, all healthcare providers must work out how to convert themselves from body repair centres into health hubs – how the NHS will become the NWS, the National Wellness Service, and how private providers can make premiums more attractive to more people by cutting avoidable claims.