Prevention is better than cure – except in healthcare?
Authors: Stephen Bevan
17 June 2014
As in many areas of public policy, we seem to be better at deploying our resources in healthcare when a crisis happens as opposed to using them to prevent the crisis in the first place. This is especially the case when we consider the 15 million of us (and rising) who are living with long-term health conditions – many of which are preventable. With half of GP appointments and two thirds of outpatient and A&E visits already accounted for by people with long-term conditions, and £7 out of every £10 the NHS budget currently spent in this area, it is vital that the NHS finds new ways to work more efficiently.
A report - Recipes for Sustainable Healthcare - published today by the College of Medicine makes this point very starkly, arguing that our current approaches to managing healthcare will become unsustainable expensive unless we make radical changes to the way resources are deployed and unless we find ways of improving prevention. The report makes 12 recommendations for change around three core themes – taking a patient-centred approach, harnessing technology, and helping people navigate the healthcare system – and identifies examples of innovative practice already happening in the NHS. I was part of the project steering group and my focus has been to highlight the implications of poorer health in an ageing UK workforce who will also need to work longer.
It has been estimated that approximately one third of the labour force will be aged 50 or over by 2020. Governments across the OECD have increased state pension ages or reduced the generosity of state pensions to address this issue, but as people face the prospect of working longer, they are also more likely to be doing so with the added burden of a chronic health condition. The UK workforce is already both older and sicker than in living memory with more people having a long standing health problem or disability. According to The Labour Force Survey, for example, of 7.2 million people aged 50-64 who are employed, 42 per cent are living with a health condition or disability. What is more, It is likely that chronic disease rates will continue to rise, with much of this is due to an increase in unhealthy lifestyle factors, such as poor diet, high alcohol consumption, smoking and lack of exercise.
There is no doubt that, as individuals, we all bear some responsibility for avoiding lifestyle choices which increase the risk of developing preventable long-term health problems which will affect out ability to work or our use of healthcare resources. But other things have to happen too. For example, the NHS must consider work as a clinical outcome of acre. This means that healthcare professionals need to recognise that, in most cases, work is good for people’s health and that early diagnosis and treatment which can help people stay in work must be more on an NHS priority. Second, whether they like it or not, employers are going to have to do more to promote the health and wellbeing of their employees. This may even extend to the delivery of public health messages and interventions, especially among the hard-to-reach groups who do not use primary care until it is too late.
Workforce health is at the nexus of a looming crisis of healthcare sustainability, welfare reform and active labour market policy. We can wait for the car crash to happen and clear up the mess with our traditional British efficiency. Or we can take steps now to make meaningful and long-term improvements to health education, workplace health promotion and preventative healthcare. In reality, this is the only choice we have.
Stephen Bevan was on the steering committee of the 'Recipes for Sustainable Healthcare' report.
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