Tuesday, 21 September 2010

Tory health care: sink or swim

The importance of primary health care - the tackling at a community level of the root causes of illness and hospitalisation (public health projects, preventative interventions etc.) was once summarised neatly with this hypothetical situation:

Imagine a line of people walking into a river, one by one. Hospitals - doctors, nurses and their allied professions - are in essence the equivalent of a life raft, hauling people out of the water, one at time. Those in the raft will manage to grab a fair proportion of those in the water, and safely get them out. However, they will also miss a few - the unlucky ones.

Now, what is the best way to stop this happening in such a way as to save as many lives as possible? One answer is to build a bridge over the water - so that people don't fall in in the first place.

This project may be expensive and highly time-consuming, with little apparent benefits initially visible. However, given time, investment and appropriate planning, the longer term benefits will save both lives and resources, as the life raft becomes less of an essential component.

This example is useful metaphor for public health care: frequently expensive, time-consuming and with little in the way of visible benefits, perhaps for years or decades. But, given time, programmes to tackle the root causes of illness (diet, access to preventative medicine etc.)  can reap huge long-term rewards for society.

Norway is frequently cited as a successful (and rare) example of this being put into practice in a major way. In the late 1960s, the country decided on a long-term strategy to tackle its then poor record of heart disease and related illnesses, through an extensive programme of public health intervention. In contrast to the route taken in many other western nations, Norway's social democratic traditions led it to follow a path of regulation of both the production and marketing of food and other products linked to diet (and therefore illness). The result was a transformation in the health of the general population.

The UK didn't have this tradition. Instead, investment in the more immediately visible parts of the health care system - hospitals, doctors etc. - took priority. The NHS Plan 2000 went a good deal towards addressing this problem. In it, it gave a priority to "increase and improve primary care in deprived areas" and specifically stated that "Primary care trusts will identify and maintain registers of those at the greatest risk from serious illness – concentrating particularly on areas where ill health is most prevalent – so that people can be offered preventive treatment. In the process the NHS will help tackle health inequalities".

The years following the NHS Plan put this promise into action, with large numbers of new Primary Care Centres being built around the country, right up until this year - a total of 750 in all.

The Coalition

If there is a theme developing in this current government's approach to primary healthcare, it is that they don't want much of it, which they've demonstrated by axing planned regulations on the fast food industry and cutting back on the very healthcare professionals that deliver public health projects. Something that they are set to continue doing in the approach to the Comprehensive Spending Review. Most of all, one of the main victims their anti-bureaucracy drives, Primary Care Trusts, are precisely the type of collaborative organisations (linking GPs, community health and mental health professionals) that can be used to improve levels of public health.

Still, this is the Big Society... DIY health care. If you want help, then help yourself. Sink or swim...

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