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A short-term view?
The de-prioritisation of prevention is perhaps unsurprising, given the word ‘crisis’ has dominated headlines about the NHS for months. However, the risk of this ‘short-termism’ is that failure to prioritise prevention today could see patients and the NHS paying the price tomorrow.
No disease area epitomises this reality better than CVD. Poor heart health leads to heart attacks, strokes, chronic kidney disease, peripheral arterial disease and even the onset of vascular dementia. In England, CVD is responsible for one in four deaths – the equivalent of one death every three minutes.
Prevention better than the cure
The NHS Long Term plan highlighted CVD as the single biggest area where lives can be saved over the next 10 years, with the majority of cases being preventable. Yet, it is still the case that everyday people are dying needlessly when simple preventative measures such as changes to lifestyle, earlier treatment and tackling public health challenges including obesity, smoking and alcohol misuse could have saved them.
This is by no means a new phenomenon. Since its inception, the NHS has prioritised the treatment of illness via acute hospitals, the most expensive part of the healthcare system, over measures to improve public health. The reason for this is a fundamental mismatch between the NHS’s stated ambition as a ‘service for prevention and comprehensive treatment’ and the reality, which is that today’s NHS is an ill-health service with little direct or significant capacity to drive or influence policies affecting the nation’s health. Real change requires ministerial ownership and accountability. But this too is lacking.
More frustrating still is that implementing proper prevention strategies may actually hold the answers to many of the challenges we see in the NHS at present, which threaten the sustainability of the system as we know it. Striking ambulance workers and nurses have walked out over disputes about pay, funding and working conditions. Doctors are now voting on whether to follow them out of the door, raising serious questions about the impact on patient safety. Add to this the additional context of the COVID-induced backlog, community pharmacies reporting they are on the brink of collapse, and the worst winter flu season for a decade, and you would be forgiven for struggling to look ahead to next week – let alone 10 years’ time.
Reducing the burden
But prevention has the potential to drastically reduce the future burden on the health system, simultaneously freeing up much-needed cash for the workforce. For example, total healthcare costs relating to heart and circulatory diseases are estimated at £9 billion each year, while optimising the detection of risk factors for CVD and the uptake of anticoagulants, antihypertensives and statins in line with the ambitions in the Long Term Plan could return £2.30 for every £1 spent.
This is money that could make a significant difference to an NHS creaking under its current burden. Sadly, successive governments have pulled money out of the prevention agenda (particularly at the local level) and have never given it the parity it deserves. This is partly because prevention is not a vote-winner, and the gains will not be seen until long after the government of the day has left office.
The problem with this is that short-term fixes to the challenges the NHS faces today might cover the cracks, but they won’t stop the ceiling from falling in next time the rain comes pouring down – just as we are seeing now. Instead, the Government must look beyond the horizon – focusing on the preventative measures that can contribute towards improving the overall health of our nation, reduce the burden faced by the NHS and free up resources to improve efficiency down the line. This is true in CVD, but it applies to other diseases as well.
Prevention is by no means the whole puzzle. But by putting it at the heart of the future of the NHS there is an opportunity to build a system that is truly sustainable for the long term.
This article was first published on PMLiVE on 17th January 2023.