Illness: Prevention and Cure

No one will deny that curing illness is a less good option than not sickening in the first place.  On the other hand, if I secure a scarce GP appointment to deal with some malady, I will not be pleased to have the allocated 10 minutes burned up with a lecture on my lifestyle.  Doctors and their teams are trained to cure people and have precious little time for other, even related, matters. So the DHSC has, sensibly, distinguished three separate, albeit linked, responsibilities: curing (NHS), caring (local authorities) and prevention (Public Health England, part of DHSC itself).

Given that structure, it was strange that the Secretary of State declared today “When I became Secretary of State for Health and Social Care, I made prevention one of my early priorities for the NHS and social care” when those are the two parts of his empire without that responsibility.  He makes no mention of the £7bn or so his department already spends on prevention, still less what benefits accrue.  The picture is confused by separate public health activities also funded by the NHS and local authorities.

The last two centuries saw huge health benefits from sanitation, sewage, inoculations for measles, flu, HIV etc., mostly via local authorities and the NHS, but those have become harder to find. More recent preventive measures (seatbelts, smoking, alcohol) have come from legislation, not any part of the DHSC.

Matt Hancock now exhorts us all to take part in prevention: “We need the whole nation to focus on the future: rising levels of obesity, mental illness, age-related conditions like dementia, and a growing, ageing and diversifying population”.  How exactly am I supposed to prevent nationwide mental illness or age-related conditions or the growing population? Indeed the longer we live in Hancock’s utopia, the more likely we are to suffer from “age-related conditions”.

One has to hope that next year’s Green Paper will provide some evidence for increasing the spending on the public health bureaucracy at the expense of cure and care.  Make no mistake, Hancock is proposing to divert some to the £20bn. announced by the Prime Minister in July as an NHS 70th birthday present to this purpose.

To back up the new policy the DHSC also today published two new and five old case studies. One might have expected some evidence that money spent on prevention would be more than offset by the saving on cure, but no.  Newcastle may show some benefits by 2022 and the Aylesbury case study does not even mention health benefits. It is hard to see how these case studies have any relevance at all.

The prevention paper does cite one source claiming that every £1 spent on prevention gives a £14 social (but not just health) return. This deserves further investigation as it seems unlikely that government should spend all its money on preventing ill health.

The paper in seeking to be all things to all people confuses cure, care and prevention.  Prevention apparently includes “Primary care services include: general practice (GPs or family doctors), community pharmacy, dental, and optometry (eye health) services” (p.31) and how they can be improved by, e.g., booking GP appointments online.

And “The current model of managing multiple, long-term conditions is not best for patients, nor is it sustainable. The barriers to receiving excellent care are well documented and have been covered in various reports” (p.34) addresses how cure and care should be better integrated.  It has nothing to do with public health.

Government has already conceded that cure and care should be considered together and the two Green Papers are due simultaneously this year.  The only thing that today’s announcement makes clear is that prevention/public health should be considered alongside the other two.