22 October 2015
The Conservative Party annual conference, this year held in Manchester, included a whole range of events and meetings related to health policy. These ranged from major speeches and public fringe debates and discussions through to private roundtable discussions such as that with the Life Sciences Minister George Freeman MP, held by the PHG Foundation.
Reimagining the NHS
A recurring theme in these events was that the National Health Service (NHS) in present form is broken or unsustainable. Certainly, the NHS is faced with the spiralling costs (and expectations) of modern medicine combined with a rapidly increasing patient burden from an expanding, ageing population. For these reasons, there is indeed an urgent need for new approaches that deliver maximal health benefits in a more cost-effective manner. The answers may well lie in areas of focus for the current government – making the most of opportunities offered by new science and technology for better, more affordable care; improving integration between different elements of health and social care, and between research and clinical practice; and looking towards more patient-centred models of care. We should explore all these areas alongside a radical reimagining of what a future NHS might look like.
Making the most of science
The Life Sciences Minister is a strong advocate for the need for science and technology to deliver more sustainable healthcare and better outcomes. His aspirations for the NHS to work more effectively with the research and commercial communities in order to make the UK a powerhouse of medical innovation and clinical evaluation, with a view to generating wealth for the country as well as health for the population are already well known, and form a key part of the 100,000 Genomes Project.
Making the most of the NHS to support the country’s world-renowned strength in the life sciences (as well as vice versa) seems only reasonable. The risk is that giving too much attention to wealth generation could come at the expense of population health, just as too much funding and focus on medical research could come at the expense of real widespread clinical implementation of beneficial innovations. However, as the Minister appears to have a good understanding of some of the complex barriers to clinical uptake of innovations, the current Accelerated Access review may yield genuinely useful decisions to speed up access to diagnostics, as well as novel treatments.
The other recurring health topic at the conference was the need for disease prevention - better than cure, as we all know, but perhaps more to the point also less expensive and hence a new pillar of governmental health policy . This is quite right; promoting health and wellbeing and improving disease prediction and prevention must go hand in hand with more accurate approaches to early diagnosis and personalised treatments. But what should the public role in this be? The need for individuals to take greater personal responsibility for protecting and preserving their own health (and that of their families) was referred to again and again – with some justification. Since we simply cannot rely on the NHS to ‘bail us out’ in all circumstances, the more we can do to maintain our own health the better. Nevertheless, some of this rhetoric was disturbing.
Protecting the vulnerable
There is now a fair degree of professional consensus on which behaviours are healthy and which are not, so we should try to get everyone to act appropriately – curbing alcohol, sugar and saturated fat consumption; avoiding smoking and stress; getting plenty of exercise, fruit and vegetables. Several times in Manchester it was suggested that those who failed to do so should pay the price for their own poor health and medical needs – literally. However, whilst this approach of incentivising healthy living by transferring financial responsibility for medical needs to the individual may have some merit, it also has serious limitations.
For one thing, the complex basis of common diseases is just not that simple – healthy living is no guarantee of immunity, whilst some people with multiple risk factors avoid diseases altogether. So the link between lifestyle and health outcomes in the individual is much less clear cut than it is for whole populations. Chance is involved, not to mention genetics.
In addition, the more vulnerable are likely to find it more difficult to adhere to healthy living regimens – we are not talking solely about willpower here, but also of circumstance. Requiring smoking cessation or weight loss prior to medical treatment might have a sound clinical (and financial) basis, but making such changes is likely to be hardest for those with other health issues (including mental health problems), who have less money to spend on food and unhealthier environments in which to live, and who have more stressful circumstances - perhaps because they are trying to work whilst also caring for dependent relatives, another measure enthusiastically endorsed by some politicians at the Manchester conference.
The bottom line
Life is not fair; health inequities exist. But as we seek a sustainable NHS, we should be working towards solutions that make good health accessible to as many as possible. Effective health policy should eagerly explore opportunities for more personalised and effective care, including more personalised approaches to disease prevention and supporting citizens to make healthier choices wherever possible. Some choices are easier than others, and so some may require more support than others. One size does not fit all when it comes to treatment; why do we assume that it should for prevention?