Towards a sustainable NHS
The present NHS is financially unsustainable and no amount of increased funding will ever be able to meet the exponentially increasing demands on the system. We do not have a health service but rather a very costly but effective sickness service.
The NHS is suffering from “bigness”. The consequences of excessive bigness are: the breakdown of managerial efficiency, increasingly poor communications, a widespread risk aversion ethos leading to an avoidance of decision making at every level, this in turn destroys individual’s willingness to use their experience and skills. The solution is in principal very simple; drastically reduce the size of each autonomous operating unit, eliminate the drive towards centralised control of the organisation, return decision making to the smaller units and the individuals in those units.
The second major problem is that we have trained three generations to rely on medicine to “fix them” and not to take responsibility for their own health; the consequence of great successes in drug therapy and a free medical system.
The third major factor is that the medical profession has changed over the past half century with the introduction of increasing technology, more drugs for every disease, more reliance on clinical testing and the de-humanising of medicine compared with the physicians of the past, who needed to have a closer understanding of their patients and had to offer advice and support with very meagre help from available drugs. Most doctors freely admit their training is dominated with pathology leaving very little time for ethology, or the study of health or health promotion. Even when this area is addressed we usually talk of preventative medicine that is, in itself, a negative attitude to the problem of promoting health and wellbeing.
The NHS is spending over £100 billion a year on diabetes, CHD, asthma/COPD, cancer, digestive problems, mental illness, neurological diseases and osteoarthritic related diseases that can be avoided or considerably reduced with better health promotion and health education. The incidence and severity of all the above conditions respond well to lifestyle changes and could be reduced by half or more. The cost of offering such early intervention would be easily covered by a fraction of current costs of treating the end pathologies.
We must begin with a national campaign for healthy living based on research and primarily focused on the patient taking more responsibility for their own health with maximum support from the medical profession and the government. This would involve better dietary education first and foremost; every doctor could give patients good dietary information in five minutes.
Every asthma nurse could train their patients to improve their breathing and reduce the need for medication by 50 to 90 percent and improved health for the patients. Introduction of structural therapy such as osteopathy, chiropractic and other physical therapies would reduce incidence of serious musculoskeletal problems and the need for replacement hips and knees. There would be a vast net cost saving if all this were well administered.
This long difficult journey begins with the first step of accepting the need for a major paradigm shift from a pathology post event system to an ethology preventative system based less on drug prescription and more on functional medicine or holistic health foundations.
Michael Lingard BSc(Econ). DO