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.
Bevan said 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”.
NAPC supports this purpose with the interdependent nature of physical mental health making them impossible to separate and a person-centred approach requiring us to adopt a holistic approach that cuts across single diseases and medical specialities to the range of conditions that contribute to our physical and mental health.
However, within the NHS it is clear that diagnosis and treatment of illness are prioritised above prevention. Despite longstanding calls for a more upstream approach (greater focus on proactive, preventative services) significant deficit remains and reactive services dominate. The result is the delivery of acute services that are not necessarily aligned with triple aims of the NHS around great patient experience, improved health and value from the collective contributions that fund the NHS.
It is well known that healthcare contributes to only about 10-15% of our sense of health and 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. etc.
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 should be considered. Whilst it would be unimaginable, and deeply unwelcome, that the NHS would ever be responsible for every single aspect of health 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 defined populations.
If we genuinely support this principle then we have to put our money where our mouth is and invest in more proactive, preventative care & support.
Yet there is more to health than prevention/diagnosis/treatment. Health creation is a much more comprehensive approach.
World Health Organisation:
Health is created and lived by people within the settings of their everyday life; where they learn, work, play and love. Health is created by caring for oneself and others, by being able to take decisions and have control over one’s life circumstances, and by ensuring that the society one lives in creates conditions that allow the attainment of health by all its members.
Caring, holism and ecology are essential issues in developing strategies for health promotion. Therefore, those involved should take as a guiding principle that, in each phase of planning, implementation and evaluation of health promotion activities, women and men should become equal partners.
The Health Creation Alliance
The Health Creation Alliance defines health creation as ‘a process through which individuals or communities gain a sense of purpose, hope, mastery and control over their own lives and immediate environment.’
Lord Crisp
Former NHS chief executive Lord Nigel Crisp defines it as ‘creating the conditions for people to be healthy and helping them to be so.’ We embrace both definitions and are committed to health creation alongside the wider prevention agenda.
None of these things have changed since the inception of the NHS but the greater empowerment of citizens requires us to reconsider whether our principles need updating and investing in. A health service based on diagnosis and treatment of disease invariably creates a power imbalance between citizens/patients and professionals. One that seeks to be more person centred in response to the general empowerment of its people needs to acknowledge the whole breadth of factors that effect our feeling of health & wellbeing. Whether adopting a health creation perspective within their workforce or organisation culture or working more collaboratively with partners within the communities they serve.
Perhaps the NHS is rightly biased towards diagnosis and treatment and incapable of shifting upstream due to a myriad of factors: culture, political influence, statutory responsibility but if nobody is responsible for the collective physical and mental health of a population that it can be of no surprise that this is faltering.
