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Who do we 'blame', then, for bad health?
Blame bad economics, not sick people, for the ills of the NHS
Lack of money and government inaction blight health and care system
Martin Freeman 14 OCT 2017
I shifted uncomfortably in my seat as I read the latest report into the state of our health and care system.
The two strands are “straining at the seams”, the Care Quality Commission’s (CQC) annual assessment said.
The chief executive of the CQC, Sir David Behan, warned that the future of many services was “precarious” as our unhealthy lifestyles add to the pressure.
Something has to give, and that should include the services. “The NHS was created when the big issues it was attempting to deal with were diseases like tuberculosis and polio,” said Sir David.
“Today the NHS and social care are dealing with obesity, diabetes, coronary heart disease, cancers, dementia, all of which are driven less by those middle-of-the-century diseases and more by lifestyle choices.
“The good news is that we are all living longer but the less-than-good news is that we are not living healthily longer – our healthy life expectancy is not keeping pace with our life expectancy and it is that which is driving demand.”
For evidence as to how the problem is likely to develop, have a look at what is happening at either end of the age spectrums.
By 2034 the number of people aged 85 or over will more than double to 3.2million, compared to the 2014 figure. They will carry into old age many existing long-term health problems.
Meanwhile, a study in the medical journal, The Lancet, this week showed that British children leaving primary school are 3.7kg (half a stone) heavier than a generation ago. Compared to the rest of the world, British children aren’t as obese as they used to be, but only because other countries have caught up.
Weight tends to stay on, and being obese is linked to many horrible health problems such as diabetes, heart attacks and strokes.
Let’s unpick the messages, then. What I don’t like is the underlying idea that some might extract: this is all our fault and we can’t afford/ don’t deserve the health and care services needed to clear up problems of our own making.
To the cost issue first: the main strain on the NHS and the care services is a lack of funding. We have a fantastic health system which we get on the cheap. Other nations, such as Germany, put far more of their GDP – national output – into health.
Despite what this government and its hair-shirt fixation with austerity would have you believe, the country isn’t up poo creek without a paddle. (And austerity, which is squeezing growth and spending from the economy, is part of the problem: it is throttling growth.)
The pressure on the NHS to make £22bn in “efficiency savings” by 2020 is a sick joke – these are cuts by any other name. Joined-up thinking, and funding, with a fully integrated health and social care system, and removal of the crazy, malfunctioning internal market, is the way to improve efficiency.
We would have GPs available to see patients who would not then rock up at A&E. We would have a care system ready to take elderly people out of hospital and cut bed-blocking. We’d have community hospitals helping ease the strain, instead of closing, or being under threat of closure, across Devon and Cornwall.
This is not a poor country. The UK can afford excellent health care for all its citizens, as long as all its citizens that can afford to do so contribute, and provided all the businesses that rely on our people and our infrastructure to make their profits also pay their way. Revenue from eBay’s UK operations: £1bn. Tax paid here last year: £1.6m.
As for our bad habits being a big part of the problem, well, yes; most of us could exercise more and eat more healthily.
But is the Government doing all it could?
Hardly. It is too in fear of the big names in the food industry to push through bigs cuts in sugar, fat and salt. It should have brought in the tax on sugary drinks years ago and moved to bring in drastic curbs on advertising of calorie-laden foods.
It should be less obsessed with the free market as a way of curing society’s ills.
It should be smarter in its thinking, more confident in its interventions. Doing small things can make a big difference.
Richard Thaler who this week won the Nobel Prize for economics, partly for his ‘nudge’ theory, showed that consumers can be encouraged to do the right thing through little changes – a classic example is making healthy food more prominent and unhealthy food less prominent in shops. David Cameron was a fan, and set up the ‘Nudge Unit’, which seems to have gone quiet with his departure from No 10.
The Government should also fix the broken housing market, ensuring that there is the social housing that this country needs. We’d have fewer families living in overcrowded temporary accommodation. Getting rid of poor quality housing in the early and middle decades of the 20th century helped improve health and life expectancy. Doing the same now, and proving homes that families can afford, would boost mental health and might make sure they had more money to spend on better quality food.
It’s not rocket science. But it is smart economics.
Blame bad economics, not sick people, for the ills of the NHS - Martin Freeman - Devon Live
The same point was made last week by the EDW blog:
Everything has consequences – particularly austerity cuts | East Devon Watch