A £20bn windfall for the NHS – but people need to take responsibility for their health and wellbeing.

On 29^th October 2018, Chancellor Philip Hammond announced an additional £20bn support for the NHS over the next 5 years. A few days later, Matt Hancock, Secretary of State for Health and Social Care, triggered a row by calling for people to take more responsibility for their health and wellbeing by making healthier lifestyle choices.

We totally agree with Matt Hancock’s approach. In fact, Healthy Life Essex was launched 13 years ago (originally as a hard copy magazine called Healthy Life – Mind, Body & Soul) with exactly that intention: encouraging people to take more responsibly for their health and wellbeing. Our aim was to do that by making information and options easily accessible to everyone.

Our approach, which was quite unique at the time, takes a very broad holistic approach that brings together not just core health subjects such as illness, diet and exercise, but also complementary and alternative therapies; wildlife and countryside; arts and crafts; volunteering; charities and community groups; sustainability and more. All these aspects of our lives impact on our physical and mental wellbeing.

For example, if our roads are congested, it isn’t just an environmental issue and a strategic problem for Highways departments to address; toxicity from air pollution has an extremely damaging impact on our health, especially children’s health.

For example, it is proven that getting out in the countryside supports our mental and physical wellbeing, so we have always had a very extensive Wildlife & Countryside events section. Most importantly, we need to encourage our children away from the screens and out in to the fresh air.

So back to my first paragraph. Firstly, will that £20bn budget be enough to resolve the well-documented NHS problems? And secondly, why was Matt Hancock criticised for his approach?

The NHS Budget

Let me start by saying that the NHS is a vast, hugely complicated behemoth and I, like most people, am certainly not qualified to make judgments about what an additional £20bn budget can achieve.

However, it is abundantly obvious that there are many administrative inadequacies and inefficiencies that need addressing. Additionally, I would suggest that the NHS needs to ensure that a more holistic approach to wellbeing is filtered down to every single person the NHS employ, including those sub-contracted to provide services.

It has been blatantly obvious to many people that the NHS isn’t a National Health Service – it is a National Illness Service that at best helps people recover from illness, but at worst, which is sadly often the case, takes a ‘sticking plaster’ approach to illness that invariably results in ever more serious health issues and ever-increasing costs.

In a speech given by Matt Hancock to the International Association of National Public Health Institutes, Matt Hancock said:

“In the UK, we are spending £97bn of public money on treating disease and only £8bn preventing it across the UK. You don’t have to be an economist to see those numbers don’t stack up.”

Social prescribing

People often need a little bit of help and guidance in making lifestyle changes. And even if they have early symptoms of a health issue, it is often not too late to make lifestyle changes that negate the need for medication. Surely a doctor’s priority should be to consider what lifestyle changes can be made, and how they can signpost their patients appropriately, before they even consider prescribing pills?

Matt Hancock is a Suffolk MP, and, in the wake of his message, it was most appropriate that a news item on BBC Look East on 5^th November featured The Leiston Surgery as the first doctor’s surgery in Suffolk to ‘prescribe’ parkrun to patients who would benefit from being more active. Apparently, this was as a direct result of a social prescribing scheme which was started earlier this year by parkrun UK and the Royal College of General Practitioners.

Whilst it is always nice to hear good news, and this is certainly a step in the right direction, let’s be clear: social prescribing has been around for many years albeit often with a different label. There were several schemes in the 1990s and the highly acclaimed Bromley by Bow Centre as established even earlier, in 1984. [The centre ‘supports people with a wide variety of integrated services based on their individual needs, because we know that health is primarily driven by social factors, not medical ones.’]

The concept of social prescribing doesn’t just centre around parkruns, albeit they are an excellent initiative, but by the referral of patients to community services which might be run by the council or a local charity. Similarly, it is well documented that engaging in the arts can benefit health and wellbeing  as highlighted in an excellent article by Paul Crawford, Professor of Health Humanities at the University of Nottingham.

Information about Social Prescribing on the NHS website suggests, as an example, that people who have been diagnosed with dementia could be referred to local dementia support groups. Seems pretty obvious doesn’t it? And yet I know from experience it rarely happens. This is one of my personal experiences:

The Southend Dementia Action Alliance (SDAA) was launched in March 2015 and has been acknowledged as one of the most progressive in the country. There are currently around 80 members on the SDAA, only a handful of which are doctors’ surgeries, and these are all comparatively recent additions to the membership. Over the last few years, many surgeries have been approached; most were not interested in getting involved and didn’t want any doctors, nurses and/or support staff taking dementia training. Most also refused to display information about the SDAA and various support groups. Not much hope of referring patients then!

As the Royal College of General Practitioners states in its article on 4^th May 2018:

“Social prescribing is not a new idea – good GPs have always done it, it just didn’t have a name – but we need to start realising the wider, long-term benefits this way of working can have, for general practice, the wider NHS, and most importantly our patients.”

Oh dear! It is blatantly obvious that by far the majority of GP practices have not embraced social prescribing in any shape or form so is the RCGP suggesting that, by implication, most GPs aren’t good GPs?!

GPs need educating

The article does continue by saying that many GP practices are just not equipped to embrace social subscribing effectively.

I would suggest that a social prescribing liaison officer role (SPLO) is introduced into each local authority area, funded by the NHS. This role would include ensuring all GPs have an up to date list of appropriate referral organisations AND that each surgery had a notice board and leaflet area with external support information that they – the SPLO – has responsibility for updating on a regular basis.

And GPs need educating! They are all required to complete a certain amount of CPD (continued professional development) each year. Surely it should be a requirement that within, say, the next three years they must attend a workshop, or even online module, on social prescribing, together with a scheduled meeting with their allotted SPLO?

As social prescribing gains momentum and becomes more mainstream, it is quite feasible that a link officer – someone who works directly with a patient to help them embrace the social prescribing options that would be available for them– can be employed in surgeries but, rather than an additional expense, this could reduce costs of other professional staff.

Equally importantly, and perhaps as a very priority, there needs to be a review of the training process for doctors and nurses.  Far more emphasis should be placed on providing practical, relevant training that focuses on how medical problems are linked to diet and lifestyle, and how interventions to encourage changes in these areas are frequently far more effective – and cost-effective – than prescribing ‘a magic bullet.’

And they must be prepared to practice the very essence of what it means to be a good doctor!

Most doctors take the Hippocratic Oath when they graduate, although there are varying forms. The most popular is the Lasagna version which, in the third and fourth sentences says:

“I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism. *

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.”

[*Therapeutic nihilism is a contention that it is impossible to cure people or societies of their ills through treatment. In medicine, it was connected to the idea that many “cures” do more harm than good, and that one should instead encourage the body to heal itself.]

The habit of prescribing antibiotics or other medication to everyone who walks in to a doctor’s surgery is clearly NOT part of the Hippocratic oath!

How much of that £20bn budget would it take to innovate doctor’s training and introduce SPLOs in each local authority? My guess is probably quite a small sum of money comparatively speaking. And from a financial perspective, I suspect any monies spent on these proposals would improve the health of the nation and reduce NHS costs considerably. In other words, over a period of several years, these changes would be self-funding.

Why was Matt Hancock criticised for his comments?

It certainly seems strange that Matt Hancock has received much criticism for suggesting people need to take more responsibility for their health and wellbeing.

On social media, the negative public response has predominantly been two-fold: firstly, many have referred to the pronouncements as moving to a nanny state and that ‘you can’t make adults do something they don’t want to do.”

And secondly, that it is easy to be fit and healthy if you are rich, but the poor cannot afford gym memberships and healthy food.

A nanny state?

There are many definitions for a ‘nanny state.’ Wikipedia says it is a view that government or its policies are overprotective or interfering unduly with personal choice. Collins English Dictionary says the nanny state tries to protect its citizens too much and makes them rely on the state too much.

My personal view is that, historically, a nanny state culture has developed not from any interference or intent by government per se, but by many members of the public abusing systems that have been put in place to protect them. A section of our society has come to rely on the welfare state to such a degree that we see a generation from that section who have no aspirations, have no intention of ever working, and believe it is the government’s responsibility to feed, clothe and house them!

This does need to be rectified albeit Universal Credit in its current format clearly isn’t the answer!

Of course, I am not referring to those who are genuinely in need: they should receive as much appropriate help from the state as possible. Unfortunately, it is those genuine cases who are often penalised because they are more ‘accessible’ than those who really do abuse the system.

Addressing the inequalities

It is the very same group of people who, statistically, are less healthy and have a lower life expectancy: often 15-20 years less than someone in a wealthier adjacent area of a town. A lot of work is being done to address these inequalities, including but certainly not limited to business mentors working with young people within their schools to foster confidence, increase aspirations and break the cycle of a poor lifestyle approach.

Many of the adults in these communities don’t want to listen. They don’t want to change their lifestyle. And yes, that is the greatest challenge.

So, the approach must be one of gentle nudging and ensuring people understand that it isn’t just the NHS and the state that will benefit: that they will feel fitter, healthier and happier if they make the necessary lifestyle changes.

You don’t need to be wealthy

And most importantly, you don’t have to be wealthy to be fit and healthy. You don’t need a gym membership. A walk in the park, in a nature reserve, the woods or along our stunning coast is free. Many parks have even introduced free-to-use gym equipment.

And you can eat healthily on a budget. It can be even more cost effective than take-aways and tastier too, particularly if you embrace an emphasis on plant-based foods. I have reviewed Elly Pear’s Let’s Eat which is full of fabulous cheap, nutritious, easy to prepare meals. But if you can’t afford to buy a book, just search online for healthy food on a budget.

Surely it is inconceivable that people don’t want to live happier lives? And if being healthier invariably leads to being happier, then that must be an aspiration for every single person in the UK. But many need to understand the link and be helped to attain a lifestyle that will bring health and happiness.

As above, that help could start, in many cases, with social prescribing. It isn’t going to be easy. Many people will not gracefully accept a suggestion to join a parkrun, for example, instead of the prescription they may be expecting.

But our GPs must be trained and have appropriate support in place. And remember their Hippocratic Oath!

So is the government being a nanny state by suggesting people take responsibility for their health and wellbeing. Most certainly not! It is a message that should have been reverberating around the corridors of power and the NHS behemoth many years ago!