Ah indeed, prevention is the mantra. My crystal ball forsees the first step - prevention of pints and going home early from the pub,followed by prevention of driving your gas guzzling Nissan Micra TM ( other cars are available) and prevention of a lingering painful death waiting for your knee replacement ( by offering conveyor belt surgery in a sort of surgical battery farm or assisted death if you can't wait that long.
Dental prevention is on the cards, so Quality Street tins will be banned and mince pies will henceforth contain hemp seeds, turnip and foraged fungi.
Prevention is better than cure…yet according to our medical students, nutrition is still not taught in any depth in medical school, even today.
30 years ago we had to memorise the Krebs cycle in intricate detail and papered our walls with interconnected diagrams of chemical formulae which we would be tested on in exams.
Yet when it came to advising our patients on nutrition for improved health outcomes, for years our dietary recommendations followed the same flawed low fat, eat less, move more model of weight management and when that didn’t work and everyone got sicker and diabetes rates soared, the obvious conclusion was we all just needed more willpower as we clearly weren’t trying hard enough.
A few years ago the headline news was that 1 in 4 nurses are obese but that is because the rate of overweight/obesity in healthcare workers mirrors the wider population.
It is no good identifying all the downstream metabolic effects of obesity on a lifesaving health check if we don’t also understand and explore an evidence based demonstrably successful nutritional preventative strategy (one that can work for all demographics not just those of us who can afford a wide variety of interesting real foods). We can’t just rely on pharmacological solutions which is where this all seems to be headed.
Exactly - early diagnosis is NOT prevention - we need to tackle the very unhealthy food environment, useless dietary guidelines and corrupt BigFood and Pharma industries before we have a hope of sorting out the route cause of modern chronic diseases.
The NHS now pays Weight Watchers and Slimming World to give six weeks courses to obese and overweight patients rather than have in house nutritionists. Both systems are built to fail so that users come back time and again. The businesses would fail if they actually worked of course.
Wasn't it Tony Blair who demanded the NHS be digitalised, at the turn of the Millennium? Twenty years later, Starmer proposes a new ten-year plan ... oh my, I can see the NHS still using pen, paper and fax in 2034.
As for Prevention: has anybody ever done any calculations and comparisons between the cost of prevention, nice new drug like yon ZumZumWater included, and cost of treatment after an illness is manifest? An illness felt by a patient, not decided by ever-changing 'diagnostic values' on the computer. An illness not cause by overmedication ...
Perhaps someone also ought to ask if all this prevention will include a radical prohibition of ultra-processed food - or is the BigFood Business too powerful for that?
Blair is a digital control freak, amongst other undesirable traits. (Some may say with justification that he would doubtless be in Jail were he ever to be charged with War Crimes, although that's another topic).
I believe the scheme cost around 10 billion, or about 7 years worth of OAP's lost heating allowance.
I know someone who worked on it at the time - said it was doomed from the start.
A 74 year old friend has just had his preventative health check. He was told he need to take statins and a prescription was issued. He asked to see his results and his cholesterol levels were no higher than at his last check up when he wasn’t told he needed to take statins… He looked up all the side effects and efficacy of statins - and has decided not to fill the prescription. Which obviously would have been free for him but not free for the NHS…
If you enter male and 74 into the QRisk or similar cv risk calculator (which are the basis for current guidelines on cardiovascular primary prevention prescribing recommendations) Im pretty sure 100% will be recommended to take statins regardless of their lipid results. Even if they enjoy excellent health their risk would be considered high by virtue of age and sex alone. The checking of his cholesterol was a pointless exercise as it did not in fact influence the decision. We waste a considerable amount of money in the NHS on checking and rechecking lipids which in my experience bob about over time but usually within the same reference change value.
Are the Digital and Prevention mantras linked? Just allow us to install this little chip in your brain and we can remotely monitor your health and top you, I mean top you up with whatever Big Pharma solution is needed to save you.
Prevention can only be a long-term strategy - any reduction in smoking won't show up for at least ten years as the risk for those that give up returns to its baseline. Ditto alcohol, I suspect. Many of the proposed interventions have a poor evidence base. Didn't we learn enough from rushing to use NPIs during the Covid pandemic? At the very least, all measures should be accompanied by a NICE-style review of costs and benefits, including the wider social impacts, like enhanced opportunities for organised crime from further restrictions on tobacco and alcohol. We might also expect a certain consistency - how does the desire for a smoke-free country square with the partial legalisation of other drugs in a harm reduction approach also favoured by public health leaders? Interventions can work, of course, but we are often slow to learn from best practice - Aberdeen matched Nordic infant mortality rates during the 1950s and 1960s by operating a well-resourced and integrated obstetric, paediatric and community health service for pregnant women and young children, despite much poverty and environmental disadvantage...but this was down to a mixture of high-quality leadership and invisibility to national policy-makers and their changing fashions.
Prevention was Bevan's mantra, and he and subsequent politicians were blind enough not to see that if you cure current ills, people will live long enough to develop expensive ones. You have only to watch one cutting edge TV surgery show to see this. Amazing things, but how many hips could you replace instead of one ten hour neurosurgery op? Anyway in terms of scale three things would work. Making people less fat. Making them not smoke. Making them unable to get mindbending drugs that ramp up mental illness and crime. Simple really.
“We will publish a 10-year plan early next year that will set out how we deliver three big shifts in the focus of the NHS:..."
Can see it now... one 'big shift' is that the humble "Sausage" will be banned...especially from pub food after 9pm. Remember the old adage that policies are like sausages, in that it’s best not to inquire too closely into how they are made.
true prevention would involve recognising that urging increase consumption of carbohydrates; since 1977; has been an unmitigated disaster; rising diabetes and hence obesity;
but then big pfarma and big food have profited mightily; so nothing will change
I made this rough outline, so people could put your detailed posts into context. The numbers do not always add up though and there are some big "holes".
About four fifths of the UK healthcare budget in 2023 (£292 billion) was spent by the NHS, local authorities, and other public bodies. Germany spends about £309 billion and France £257 billion on healthcare.
The public budget for health services in England in 2022 was £182 billion, divided into day to day spending (£171 billion) and capital expenditure (£11 billion). Additionally, £10 billion was allocated to Wales, £17 billion to Scotland and £6 billion to Northern Ireland.
Of the day to day spend about £151 billion was allocated to NHS England and £16 billion to the central budgets of the Department of Health and Social Care and its arms-length bodies.
Such bodies include the UK Health Security Agency (which replaced Public Health England) (£0.4 billion), Health Education England (£5 billion), Care Quality Commission (£0.3 billion), National Institute of Health and Care Excellence (£0.7 billion) and the Healthcare Services Safety Investigation Body (which came into being a year ago to investigate patient safety concerns across independent healthcare settings and the NHS in England)( £0.5 billion).
Of the £151 billion allocated to NHS England, £119 billion was allocated to integrated care boards, In addition, £17 billion is allocated to primary care, £3 billion to public health, £0.5 billion to NHS England administration and £23 billion to direct specialist commissioning.
The integrated care boards passed £95 billion to NHS trusts and independent healthcare providers. It is not clear where the other £24 billion was allocated, but most is likely some was used to administer the NHS internal market.
£95 billion was allocated to 215 English NHS Trusts and 69 independent healthcare providers. Trusts in England spend about £2 billion on PFI and about £19 billion on drugs. £71 billion was allocated to their staff costs in 2023.
For comparison, about £37 billion was allocated to prevention in 2021 by the Department of Health and Social Care and spent via arms-length bodies and integrated care boards. Just under half of this budget was allocated to early disease detection programs and healthy condition monitoring programs, and just under a third to immunization programs.
Ah indeed, prevention is the mantra. My crystal ball forsees the first step - prevention of pints and going home early from the pub,followed by prevention of driving your gas guzzling Nissan Micra TM ( other cars are available) and prevention of a lingering painful death waiting for your knee replacement ( by offering conveyor belt surgery in a sort of surgical battery farm or assisted death if you can't wait that long.
Dental prevention is on the cards, so Quality Street tins will be banned and mince pies will henceforth contain hemp seeds, turnip and foraged fungi.
Remind us what Soylent Green was again???
Prevention is better than cure…yet according to our medical students, nutrition is still not taught in any depth in medical school, even today.
30 years ago we had to memorise the Krebs cycle in intricate detail and papered our walls with interconnected diagrams of chemical formulae which we would be tested on in exams.
Yet when it came to advising our patients on nutrition for improved health outcomes, for years our dietary recommendations followed the same flawed low fat, eat less, move more model of weight management and when that didn’t work and everyone got sicker and diabetes rates soared, the obvious conclusion was we all just needed more willpower as we clearly weren’t trying hard enough.
A few years ago the headline news was that 1 in 4 nurses are obese but that is because the rate of overweight/obesity in healthcare workers mirrors the wider population.
It is no good identifying all the downstream metabolic effects of obesity on a lifesaving health check if we don’t also understand and explore an evidence based demonstrably successful nutritional preventative strategy (one that can work for all demographics not just those of us who can afford a wide variety of interesting real foods). We can’t just rely on pharmacological solutions which is where this all seems to be headed.
Exactly - early diagnosis is NOT prevention - we need to tackle the very unhealthy food environment, useless dietary guidelines and corrupt BigFood and Pharma industries before we have a hope of sorting out the route cause of modern chronic diseases.
The NHS now pays Weight Watchers and Slimming World to give six weeks courses to obese and overweight patients rather than have in house nutritionists. Both systems are built to fail so that users come back time and again. The businesses would fail if they actually worked of course.
spot on
Wasn't it Tony Blair who demanded the NHS be digitalised, at the turn of the Millennium? Twenty years later, Starmer proposes a new ten-year plan ... oh my, I can see the NHS still using pen, paper and fax in 2034.
As for Prevention: has anybody ever done any calculations and comparisons between the cost of prevention, nice new drug like yon ZumZumWater included, and cost of treatment after an illness is manifest? An illness felt by a patient, not decided by ever-changing 'diagnostic values' on the computer. An illness not cause by overmedication ...
Perhaps someone also ought to ask if all this prevention will include a radical prohibition of ultra-processed food - or is the BigFood Business too powerful for that?
Blair is a digital control freak, amongst other undesirable traits. (Some may say with justification that he would doubtless be in Jail were he ever to be charged with War Crimes, although that's another topic).
I believe the scheme cost around 10 billion, or about 7 years worth of OAP's lost heating allowance.
I know someone who worked on it at the time - said it was doomed from the start.
A 74 year old friend has just had his preventative health check. He was told he need to take statins and a prescription was issued. He asked to see his results and his cholesterol levels were no higher than at his last check up when he wasn’t told he needed to take statins… He looked up all the side effects and efficacy of statins - and has decided not to fill the prescription. Which obviously would have been free for him but not free for the NHS…
If you enter male and 74 into the QRisk or similar cv risk calculator (which are the basis for current guidelines on cardiovascular primary prevention prescribing recommendations) Im pretty sure 100% will be recommended to take statins regardless of their lipid results. Even if they enjoy excellent health their risk would be considered high by virtue of age and sex alone. The checking of his cholesterol was a pointless exercise as it did not in fact influence the decision. We waste a considerable amount of money in the NHS on checking and rechecking lipids which in my experience bob about over time but usually within the same reference change value.
https://www.bmj.com/content/368/bmj.m149 Explains the normal variation in test results
a very wise friend; best place for statins is down the toilet
Are the Digital and Prevention mantras linked? Just allow us to install this little chip in your brain and we can remotely monitor your health and top you, I mean top you up with whatever Big Pharma solution is needed to save you.
Prevention can only be a long-term strategy - any reduction in smoking won't show up for at least ten years as the risk for those that give up returns to its baseline. Ditto alcohol, I suspect. Many of the proposed interventions have a poor evidence base. Didn't we learn enough from rushing to use NPIs during the Covid pandemic? At the very least, all measures should be accompanied by a NICE-style review of costs and benefits, including the wider social impacts, like enhanced opportunities for organised crime from further restrictions on tobacco and alcohol. We might also expect a certain consistency - how does the desire for a smoke-free country square with the partial legalisation of other drugs in a harm reduction approach also favoured by public health leaders? Interventions can work, of course, but we are often slow to learn from best practice - Aberdeen matched Nordic infant mortality rates during the 1950s and 1960s by operating a well-resourced and integrated obstetric, paediatric and community health service for pregnant women and young children, despite much poverty and environmental disadvantage...but this was down to a mixture of high-quality leadership and invisibility to national policy-makers and their changing fashions.
Prevention was Bevan's mantra, and he and subsequent politicians were blind enough not to see that if you cure current ills, people will live long enough to develop expensive ones. You have only to watch one cutting edge TV surgery show to see this. Amazing things, but how many hips could you replace instead of one ten hour neurosurgery op? Anyway in terms of scale three things would work. Making people less fat. Making them not smoke. Making them unable to get mindbending drugs that ramp up mental illness and crime. Simple really.
“We will publish a 10-year plan early next year that will set out how we deliver three big shifts in the focus of the NHS:..."
Can see it now... one 'big shift' is that the humble "Sausage" will be banned...especially from pub food after 9pm. Remember the old adage that policies are like sausages, in that it’s best not to inquire too closely into how they are made.
true prevention would involve recognising that urging increase consumption of carbohydrates; since 1977; has been an unmitigated disaster; rising diabetes and hence obesity;
but then big pfarma and big food have profited mightily; so nothing will change
"Without action on prevention, the NHS will be overwhelmed"
One wonders if there is anything that doesn't overwhelm the NHS 🤔
One also wonders if the NHS is a Tax Payer -> Big Pharma washing machine 🤔
I made this rough outline, so people could put your detailed posts into context. The numbers do not always add up though and there are some big "holes".
About four fifths of the UK healthcare budget in 2023 (£292 billion) was spent by the NHS, local authorities, and other public bodies. Germany spends about £309 billion and France £257 billion on healthcare.
The public budget for health services in England in 2022 was £182 billion, divided into day to day spending (£171 billion) and capital expenditure (£11 billion). Additionally, £10 billion was allocated to Wales, £17 billion to Scotland and £6 billion to Northern Ireland.
Of the day to day spend about £151 billion was allocated to NHS England and £16 billion to the central budgets of the Department of Health and Social Care and its arms-length bodies.
Such bodies include the UK Health Security Agency (which replaced Public Health England) (£0.4 billion), Health Education England (£5 billion), Care Quality Commission (£0.3 billion), National Institute of Health and Care Excellence (£0.7 billion) and the Healthcare Services Safety Investigation Body (which came into being a year ago to investigate patient safety concerns across independent healthcare settings and the NHS in England)( £0.5 billion).
Of the £151 billion allocated to NHS England, £119 billion was allocated to integrated care boards, In addition, £17 billion is allocated to primary care, £3 billion to public health, £0.5 billion to NHS England administration and £23 billion to direct specialist commissioning.
The integrated care boards passed £95 billion to NHS trusts and independent healthcare providers. It is not clear where the other £24 billion was allocated, but most is likely some was used to administer the NHS internal market.
£95 billion was allocated to 215 English NHS Trusts and 69 independent healthcare providers. Trusts in England spend about £2 billion on PFI and about £19 billion on drugs. £71 billion was allocated to their staff costs in 2023.
For comparison, about £37 billion was allocated to prevention in 2021 by the Department of Health and Social Care and spent via arms-length bodies and integrated care boards. Just under half of this budget was allocated to early disease detection programs and healthy condition monitoring programs, and just under a third to immunization programs.
https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthcaresystem/bulletins/ukhealthaccounts/2022and2023