Anna Coote: The NHS could do more than patch us up

Policies on health and health care cannot be developed in isolation from each other
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The Independent Online

Personalisation is the rallying cry with which the Blair Government is marching towards the next election. The new NHS improvement plan, launched by the Health Secretary, John Reid, last week, tells us that "Patients' desire for high-quality personalised care will drive the new system." People will have "greater personal choice ... to call the shots about the time and place of their care, empowering them to personalise their care to ensure the quality and convenience that they want."

But all this puts the cart before the horse. Instead of worrying about how to keep people well, it fixes on the question of how people should be treated when they are sick. Derek Wanless, the former head of NatWest bank, has estimated for the Treasury that failure to give priority to prevention could cost an additional £30bn a year by 2020.

Many of the illnesses that cost the NHS dear are avoidable. Heart disease, arthritis, asthma, bronchitis and other respiratory diseases, diabetes and other effects of obesity could, in most cases, be prevented. The prize would be immense: longer years of higher quality life for millions of people; a significant reduction in demand for the NHS, so that it can cope better with treating and caring for the unavoidably sick, and a great chunk out of the taxpayer's bill.

Last February, Mr Reid appeared to take note of the Wanless warnings. He announced an intention to make the NHS "a health service not a sickness service", with an ambitious round of public consultations and a White Paper later in the year. Major health risks like smoking and obesity, and the Government's interest in tackling them, began to make headlines.

However, keeping a focus on health, rather than health care, requires a massive and sustained effort. It implies a challenge to powerful interests within the NHS, where status, job satisfaction and income derive more from making people better rather than keeping them well.

It calls for a more subtle and demanding political quest than "reforming the NHS" and "promoting patient choice". It is about orchestrating a relationship between health services, local government, employers, voluntary organisations, individuals and community groups, to tackle the causes of illness and promote the means to better health - not just now, but over five, 10, even 20 years.

Sadly, since last week's launch of the new NHS plan, the talk has reverted to waiting times, commissioning budgets, hospitals and service delivery. Ministers may argue that public health policies are in the pipeline, and we should wait for the promised White Paper this autumn. But policies on health and health care cannot be developed in isolation from each other. Giving higher priority to preventing illness would mean changing the character of the NHS and transforming the way health services are organised.

Take the first point of contact between the individual and the health service. Usually it goes like this: you feel ill, you go to the doctor, you get advice, and maybe a prescription, and off you go again until next time you feel ill.

If the main goal were to keep people well, that encounter could be very different. As a healthy individual, you would go in for a check up: height, weight, blood pressure, and whatever else is appropriate for your stage in life and personal history. You would talk to the doctor, or maybe the nurse, about what is needed to safeguard or improve your health. This might be about diet, exercise, smoking, or drinking. Or it might be about whether you need help finding a job or childcare, or sorting out housing problems, or dealing with anxieties at work or at home. There is strong evidence, after all, that these are the things that most keenly affect your chances of being healthy.

You would then create, with health professionals and other advisers, a personalised health plan, which sets out what you need to stay healthy or get better. It would say, with your agreement, what you are responsible for and what you expect from the NHS. (For example, you might resolve to take more exercise and gain access to a gym; you might eat more fresh vegetables, and get help with claiming benefits.) You would return, at appropriate intervals, to check on progress and revise your plan, which could be stored electronically (as is mooted for patient notes), so that it is easily accessible whenever you need it.

There is every reason to believe that this approach will be widely welcomed. A new survey on public attitudes to public health is published today by the King's Fund. It shows that three in four people think government should actively discourage people from doing things that put their own, or others', health at risk. More than two-thirds say the NHS should focus on preventing illness, not just caring for the sick.

If "personalisation" is the rallying cry, then let it be put to better use. Let local health services be organised so that every citizen, healthy or sick, has a personalised health plan that defines responsibilities and plots a course for staying well from the cradle to the grave.

The writer is health policy director at the King's Fund, a London-based medical charity

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