What should the NHS do?
‘The future health of millions of children, the sustainability of the NHS, and the economic prosperity of Britain all now depend on a radical upgrade in prevention and public health’.
NHS Five Year Forward View
Lifestyle related illness is an increasing burden for the NHS. However, the cuts in funding for public health and the limited progress on public health achieved with the food and drink industries mean that the NHS’ role in prevention has become increasingly important.
When people are ill they need diagnosis and treatment. That’s really important. But so too is what health professionals can do to help people stay healthy and so reduce the number of people needing treatment.
What training and skills will health professionals needs?
Doctors, the most senior health professionals, have traditionally been trained to diagnose and treat illness, not prevent it. So, looking to the future, skills in preventative health will need to be developed at medical school and on university nursing courses and through continuing professional development (CPD). Until this happens the risk is that many health professionals will continue to wait until a patient presents with symptoms.
This probably raises a more fundamental question about the role of doctors in the 21st century:
Are doctors the last line of defence when public health measures have failed, waiting in their medical centres and hospitals for the casualties of life to make their way there for diagnosis and treatment?
Or, do they have a more active role to play in helping maintain health by preventing illness – and so reducing the number of people who need treatment? If so, is this likely to involve new ways of working, including outside their traditional medical environments? And is there a greater potential role here for health trainers, midwives, community nurses and others (perhaps in the private and voluntary sectors) to lead on prevention – where appropriate redirecting resources and recruitment to support this vital preventative work?
The need is clear. However, how can we ensure doctors (and other health professionals) have the confidence and skills to address lifestyle issues effectively with their patients before they start to make them ill?
Questions that need to be answered
- Where and when can doctors most effectively intervene to reduce the risk of illness – ideally as early as possible in life?
- What training and support do they need to achieve this – ideally starting at medical school and in nurse education, plus continuing professional development (CPD) for existing doctors and other health professionals?
- How much are doctors taught about the importance of exercise and diet, both to prevent illness and to assist recovery? And do they act on this knowledge e.g. exercise on prescription?
- Where unhappiness is a possible cause of risk factors like obesity, with people turning to ‘comfort food’ (or smoking or alcohol) to try to compensate, are GPs trained and do they have the time to help their patients address the issues here, as opposed to the traditional route of providing medication or referring to a specialist?
- How can we ensure that the objectives in the GMC’s Outcomes for Graduates correlate with the needs of the NHS and in particular the identified need for, ‘a radical upgrade in prevention and public health’ as set out in the NHS Five Year Forward Plan?
- How can we ensure health professionals are effective role models? Overweight nurses, midwives and doctors are unlikely to have credibility when advising patients to lose weight. Should this perhaps (with support) become a Fitness to Practice issue?
- How can hospitals also lead by example, for instance through the quality of food they provide to patients, in canteens and in vending machines? This is a point the NHS Chief Executive, Simon Stevens, has recognised but progress here remains slow. We visited a number of London hospitals in 2019 and each still had vending machines selling primarily food high in sugar, salt, saturated fat and refined carbohydrate.
- How active a role should Public Health England play? In previous generations the UK used hard hitting public health advertising to warn of the danger of AIDS and later of smoking. Is it time for similar action in relation to food that increases the risk of obesity, type 2 diabetes and cardiovascular disease?