Hospitals in the UK are facing severe financial difficulty due to a large increase in hospital admissions. In response, Jeremy Hunt has pursued the option of a 7-day NHS in order to deal with increased demand. But besides being highly disruptive, moves towards a 7-day NHS merely seek to manage the problem the NHS is facing instead of tackling it head-on. To properly address the problem of increased demand means tackling ill health at its source, by investing properly in the future health of the UK population.
Diseases caused by lifestyle choices take up a large proportion of NHS spending. Smoking is estimated to cost the NHS between £2bn and £5bn a year, accounting for 1.6 million hospital admissions in 2014. According to the government's national statistics, alcohol accounts for another million admissions per year and costs the NHS approximately £3.5bn a year. The impact of obesity is similar, costing the NHS over £4bn a year. That's without taking into account the overall cost of those factors to society, due to absences from work and lost economic output.
GPs in particular play an important role in preventing ill health caused by lifestyle factors. As doctors working within the community and coming into regular contact with their patients, GPs are clearly best placed to identify emerging health problems or risk factors to health. The Royal College of General Practitioners recognises the role GPs play in preventing disease by promoting healthier lifestyles, but with the current standard GP appointment being just 10 minutes long, it is unsurprising that it has taken a back seat for many practitioners. A UK study showed that GPs seeing patients for shorter consultations were less likely to give lifestyle advice. Yet some GPs estimate that between 70% and 80% of their consultations are actually spent dealing with lifestyle-related illnesses.
The responsibility of improving public health as a whole lies with Public Health England (PHE), an organisation whose mandate from the government is to improve the nation's overall health and wellbeing while reducing health inequalities. Last year PHE operated on a budget of £3.9billion. That is a substantial sum, but it is money aimed at tackling the causes of health problems like cancer, stroke and heart disease which cost the NHS many times that figure to treat. With some GPs seeing between 40-60 patients a day, the work of Public Health England is vitally important in relieving the pressures on tomorrow's NHS.
Most of the money which PHE receives from the government goes to local authorities. It is spent on a range of initiatives aimed at promoting healthier lifestyles, such as tackling levels of obesity and reducing alcohol and cigarette consumption. Local authorities now also offer other essential services, such as drug and substance misuse clinics and sexual health services including those aimed at HIV prevention. They additionally contribute to public health through many other services they provide including housing, transport, policing, and the provision of recreation and leisure services.
That is why, when local authority budgets were cut by £200 million last year, Trust and CCG finance directors responded, arguing that council cuts were negatively affecting health care performance and resulting in rising waiting times. There have been many headlines about cuts leading to the closure of council gyms and sports centres. But other, lower-profile, services including school nursing, smoking cessation services and healthy eating initiatives have been cut too. In March last year, the Joseph Rowntree Foundation released a report investigating the knock-on effects for other public bodies including the NHS. In it, they concluded that "long-term, preventative approaches are being compromised by the need to make short-term savings."
This year has seen another blow dealt to public health, with Public Health England itself being affected by departmental spending cuts. It is expected to save £77 million in 2016, while further planned cuts see its funding reduced by approximately 3.9% every year until 2020. NHS budgets were meant to be ring-fenced by David Cameron as part of the 2015 Conservative manifesto. But as PHE is considered a government body, its budgets now fall outside of the protected 'NHS' funding. These cuts are likely to further damage local services and contribute to the current crisis within the NHS.
According to research, spending on public health interventions is usually cost-effective. For example, the National Institute for Clinical Excellence (NICE) ran a case study in cost effectiveness in Bury to see whether smoking cessation funding was delivering value for money. In 2013 they published their findings, which showed that each pound Bury Metropolitan Council spent on interventions was paid back within two years and led to a return of £9.35 over a patient's lifetime. They also found that an investment of £751,000 in one year resulted in 2,135 fewer GP and hospital admissions, and 1272 fewer days of work lost to smoking-related illnesses.
As some of the investments made into public health take 30-40 years before the benefits are felt, it can be tempting to downplay their importance. But saving £1 to spend £10 tomorrow is no way to save our National Health Service from its current financial deficits. The King's Fund has warned that "further cuts to public health spending and activity will be the falsest of false economies, not least for the NHS".
Though the Conservative Party pledged to protect the NHS from spending cuts, it has chosen to forgo that responsibility by cutting investment in public health upon which the NHS relies. Additionally, current government plans to pursue a 7-day NHS may prove to be wholly ineffective without proper investment in preventing illness in the first place. In order to save money in the future and to make our NHS sustainable, I believe the evidence shows that we must invest more in preventative medicine and in informing the lifestyle choices of the public. Supporting people to live independently healthy lives is just as important as treating ill health when it occurs.
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