It would be an understatement to say that the health and social care’s 2022 was punctuated with problems.
The Covid legacy combined with perennial winter pressures have taken the NHS over the edge, with A&E and routine care waiting times at an all-time high. Staff shortages and high turnover, particularly in social care, have only exacerbated the situation. Continued industrial action provides the cherry on top of a particularly unpalatable cake.
Over its illustrious 75 years, the NHS has been faced with further challenges in society and on each occasion, this has led to reform.
The recent focus has been on downplaying the role of internal competition across the country, and developing a focus on locally-based partnership working with local authorities to deliver care.
The gravity of today’s situation is forcing policymakers’ hands. Politicians and the NHS each accept that reforms can no longer be about the care delivered, it has to include a focus on prevention.
Shifting focus from treatment-based care
On the surface, the benefits of a proactive approach are clear and obvious. By focusing on preventing illnesses, the demand on primary and secondary care services is reduced.
Last week, the NHS revealed that ‘virtual wards’ would be a key weapon in its armoury in the continued fight to recover emergency and urgent care. Virtual wards enable people to receive the acute care, remote monitoring and treatment they need in their own home.
Preventing patients from being in hospital unnecessarily demonstrates one part of the preventative care equation. NHS England’s recommendation to local NHS organisations across the country is to embrace virtual wards, and at a minimum, start by supporting frailty patients.
With aging population in mind, the rationale is clear. Within the next 25 years, the number of people over the age of 85 is expected to double to 2.6 million people in England alone. As people age the risk of developing illnesses and becoming frail increases, ensuring they are able to safely recover and have their healthcare supported at home wherever possible is a clear step on the road to preventative care.
More government intervention
Part of a prevention-centred healthcare system would involve greater government intervention in nudging, if not outright imposing, healthier life choices.
The Soft Drinks Industry Levy (better known as the “sugar tax”) introduced in 2018 is the most prominent example in recent years of the government using its tax and regulatory levers to promote better health. While the levy did not reduce overall consumption of soft drinks, it did force soft drink manufacturers to reformulate drinks to reduce sugar contents in a bid to avoid the higher levy rates.
Research from the University of Cambridge suggests the levy has reduced obesity levels in girls aged 10 to 11 years, although no measurable effect was found in boys of the same age. The mixed results indicate that further strategies are needed to tackle childhood obesity overall.
Restrictions on unhealthy foods promotions (“buy one get one free ban”) are set to come into effect in October after being delayed by more than a year. The measure will ban multibuy deals on foods and drinks high in fat, salt, or sugar, as well as free refills of soft drinks. Like the sugar levy, these restrictions are developed through a preventative lens, with an aim to tackle obesity.
Whilst the measures were delayed ostensibly due to the cost-of-living crisis, given that 63% of adults are overweight or living with obesity and 1 in 3 children leave primary school overweight or obese, at the cost of £6 billion a year for the NHS, clearly a more proactive approach is needed.
Finally, tobacco control must also be integral to any prevention strategy. The charity Action on Smoking and Health estimates that smoking costs the NHS £2.4 billion a year and £1.2 billion a year for social care.
The Khan Review and its recommendations formed the basis of the government’s own “smoke-free” pledge, where the prevalence of smoking among the population would fall to 5% or less by 2030. This will not be met until 2037 at the earliest according to a review in February 2022. A more robust strategy is therefore needed to meet the aim.
The Shadow Health Secretary Wes Streeting has said that an incoming Labour government would consider phasing out the sale of tobacco similar to New Zealand, which would be key step in ensuring future generations do not start in the first place.
What’s holding us back?
If the social and economic benefits of preventative healthcare are clear and effective, why have successive governments been so hesitant and slow to implement it? One of the key factors often cited is a cultural one: fear of the “nanny state”. Policymakers often fear accusations of wanting to create policies that unnecessarily interfere in people’s lives. Both the indoor smoking ban of 2007 and sugar levy faced such accusations. Yet, in the long run, both measures have largely been accepted by the public.
Secondly, the NHS continues to dominate health policy to the extent that any focus on measures outside the system garner little interest from both voters and the media. Strains in the social care sector, for example, continue to be viewed in the context of overburdening the NHS rather than an issue in its own right.
A preventative strategy simply has to be holistic and is no longer the sole domain of the NHS.
In it for the long run
With Governments beholden to election cycles, policies can be delivered with a short to medium term focus in mind.
Many will accept that preventative healthcare measures will not immediately reduce the NHS backlog or the demand on social care.
Some may even argue the principle of preventionist policy such as changing diets, drinking and smoking habits could even by met by short-term opposition.
However, a failure to think beyond care and address prevention will result in an NHS crisis far worse than the current one in the decades to come.