The NAPC has long been championing the need to get serious about prevention, so it was good to hear Matthew Taylor, CEO NHS Confed, agreeing with us that a radical change is needed to “address an NHS stuck in perpetual crisis management”.
The original NHS Act refers to the NHS as a Comprehensive Health Service designed to secure improvement in the physical and mental health of the people of England and Wales and the prevention, diagnosis and treatment of illness. Indeed, Bevan himself is quoted as saying that a comprehensive service would “ensure that every man and woman and child can rely on getting ALL the advice and treatment and care which they may need in matters of personal health”.
Despite longstanding calls for a more upstream approach (greater focus on proactive, preventative services) it is clear that within the NHS diagnosis and treatment of illness are prioritised above prevention. Nearly all the success measures within the NHS are based on how good we are at doing things to people when they become ill and acute medical services are prioritised above supporting people staying well. The result is an emphasis on the delivery of acute services that are struggling to deliver the triple aims of the NHS around great patient experience, improved health and best value from the collective contributions that fund the NHS. It increasingly feels that we have set ourselves up to fail.
It is well known that healthcare contributes to only about 10-15% of our sense of health. Therefore, without a more robust approach to prevention the NHS can too often end up treating people and returning them to the conditions that made them sick, whether that is poverty, lifestyle, unemployment, poor housing, low person activation etc. This further exacerbates health inequality at increased social cost and undermines the economic growth that funds our public services.
If our physical and mental health is inextricably linked to our social health, then the explicit inclusion of social health alongside physical and mental health within the NHS’ sense of purpose must be considered. Whilst it would be unimaginable, and deeply unwelcome, that the NHS would ever be responsible for every care and support aspect of our health & well-being the acknowledgement of this inextricable link can only enhance people’s experience in healthcare diagnosis and treatment and drive an even greater urgency to collaborative working across institutions (public and private) serving the health of our communities. This is just as true for national bodies as it is for local partners.
If we truly value proactive prevention and genuinely want to update this longstanding founding principle of the NHS so it is fit for today’s challenges then we need to act differently now. This requires us to align our measures of success around what we value and to shift our investment focus to more effective proactive, preventative care & support designed by activated professionals from health & care in partnership with their communities.
