‘Prevention’ Will Not Save the NHS. Just Ask Every Health Secretary of the Past 25 Years
The Labour Government wants to shift the NHS from “analogue to digital” and from “treatment to prevention”.
The PM, Keir Starmer, in a speech on the NHS at the King’s Fund, said: “The NHS is uniquely placed for the opportunities of big data and predictive and preventative medicine”, and ”we’ve got to be much bolder in moving from sickness to prevention”,
The rapid-fire Darzi report said it had diagnosed the NHS woes, and Darzi wrote in the Guardian that he had now found the cure: a “pivot to prevention”.
All of this has impressed the Rt Hon Wes Streeting. The new Secretary of State for Health and Social Care at the Institute for Public Policy Research said: “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: from analogue to digital, hospital to community, and sickness to prevention.”
Speaking at the Labour Party conference this week, Streeting said, “Without action on prevention, the NHS will be overwhelmed.” He’ll be “going hell for leather” to enact the changes.
Yet the prevention mantra is a familiar line for a Health Secretary to trot out.
Here at the Trust the Evidence office we thought we would ask how common the prevention mantra is amongst the 13 Health Secretaries we’ve had since 2000.
As it turns out, prevention is a go-to line for all Health Secretaries (See the PDF for the table of statements).
It was a favourite strategy for the Labour Government until 2010. Alan Milburn said: “The NHS will be able to make further progress still by focusing not just on further advances in treatment — through faster waiting times and new drugs —but also on prevention.” John Reid said there would be an emphasis on prevention rather than just cure if Labour retained power.
The party did retain power. In 2007, Patricia Hewitt published ‘Our Health, Our Care, Our Say: A New Direction for Community Services’. Guess what? “Better prevention now will avoid costly illnesses later.” Alan Johnson replaced her in the Health Secretary merry-go-round, and guess what? “The health service would put greater emphasis on prevention of illness,” he said.
Andy Burnham took up the reins as the Labour term of office ended. He must have had the same advisors as he told the news: “For the NHS, that is the direction it’s got to go – a prevention service to keep people healthy in the first place.” The case for investment in preventive care was “cast-iron”.
When the Conservatives came to power, they were also quick to the mark regarding prevention. Andrew Lansley said: “But as well as re-focusing the treatment side of healthcare, we need to do far more on prevention.”
In 2013, the DHSC published ‘Living Well for Longer: A Call to Action’ to reduce avoidable premature mortality. And guess what? “If we are to tackle the challenge we face, we need to make improvements across the three domains of prevention, early diagnosis and treatment.” When I’m a celebrity, Matt Hancock came into the job he was also a prevention disciple as he made prevention one of his earliest priorities for the NHS and social care, publishing the ‘Prevention is better than cure: our vision to help you live well for longer’ plan.
As the Tories went into meltdown, they had a raft of Health Secretaries. However, all of them were able to get in on the prevention act. Javid delivered a white paper that championed health and well-being as a real priority and greatly emphasised prevention. Barclay (who did the job twice) showed his direction of travel — you guessed it — prevention.
Therese Coffey – who was only on the job for about 30 days, still managed to say that “prevention is, of course, at the heart of what we do so that people do not need to turn to the health service at all for treatment”. Finally, Streeting’s predecessor, Victoria Atkins, was gung-ho for more – guess what – prevention. “There is, of course, one topic fundamental to my plan to reform the NHS to make it faster, simpler and fairer – and that is prevention,” she said.
So when Streeting gets up and emphasises more prevention, you may want to ask how this differs from all those who have gone before him and whether they all have the same advisors and speech writers to hand.
Streeting said he “won’t let us down” at this week’s conference. There’ll be more “preventive, personalised and precision medicine for the many”. And when the next Health Secretary replaces Streeting, can you guess his or her priorities?
This post was written by two old geezers who have seen 20 Health Secretaries come and go while in the NHS. Next up?
Dr. Carl Heneghan is the Oxford Professor of Evidence Based Medicine and Dr. Tom Jefferson is an epidemiologist based in Rome who works with Professor Heneghan on the Cochrane Collaboration. This article was first published on their Substack, Trust The Evidence, which you can subscribe to here.
To join in with the discussion please make a donation to The Daily Sceptic.
Profanity and abuse will be removed and may lead to a permanent ban.
‘Prevention’ Will Not Save the NHS … The Labour Government wants to shift the NHS from “analogue to digital” and from “treatment to prevention”.
This government cannot save, fix, redeem, or cure the NHS; no government can. This is because the NHS is beset with advanced and incurable bureaucratic decay. The heart of the political problem is that the dominant class of our country, the state bourgeoisie (the class that has risen to prominence on the back of the vast growth of state power since the War), is the class which the ruling Party really represents (and not the working class). Since the only solution to the problem of the NHS is to break it up and privatise it, that would mean the ruling Party having to undermine the very existence of the only class it represents. Obviously, this isn’t going to happen. Hence the ruling Party is obliged to adopt the preposterous idea that there is some technological (for which read magical) solution to the problem of the NHS.
Well said. It is why they have been importing poverty for the last 30 years to give them a constituency to represent and carry on as usual, and Gerrymander the vote.
The trump card against privatisation is – What about the poor? Sob.
Theoretically, let’s assume these ‘prevention measures’ kicked in after ‘x’ decades, and fewer people come into hospital. I wonder how quickly the NHS would start saving money? For they would need to close wards and make staff redundant. I suspect they wouldn’t, saying they need to retain some spare capacity …. ‘just in case’.
In short, even if the Nation’s health dramatically improved, the predicted savings will never arrive.
Demand for healthcare is probably effectively infinite. If they did by some chance get benefit from this “prevention” thing, it would free up resources to attend to less and less serious health issues over time. Realistically you just have to set a budget that you want to spend and ration what you provide accordingly, but good luck getting people to vote for a real terms reduction in health spending.
No. People pay for their own medical care out of the wealth they produce. If they don’t, for whatever reason create enough wealth to do so, they die.
The alternative is what it is now, non-wealth producers live to consume more and more of the wealth of others. This is gradual impoverishment of society. It is unsustainable because eventually the proportion of the population creating the wealth, is insufficient to pay for neither their own welfare nor that of the parasites. And better yet – we are importing more parasites from schitt-holes round the World.
That is precisely why we are in the current State. We’ve burnt the wealth candle down to the base. There’s none left. More money from taxation? What happens when there’s nothing left to tax?
Oh I wasn’t particularly advocating for the NHS or completely socialised healthcare – just suggesting that if demand is infinite because the product is perceived as “free” then you’re not really going to “save money” unless you cap what you are providing by limiting the budget.
I think if you have a really healthy economy and good human capital then it’s OK to have a social safety net of some kind, including healthcare. But most of the policies of the past decades have taken us in completely the opposite direction – as you point out.
But you cannot prevent old age, nor the diseases that arise because of old age – dementia, diabetes, chronic renal, cardiovascular, pulmonary problems, arthritis, sight and hearing loss, to name a few. These conditions arise because the body wears out the older it gets, the immune system weakens, cell replacement slows down, cells go rogue and become cancerous. The biggest problem the NHS is facing is a growing elderly population with these conditions which are costly and time consuming to treat. When the NHS was created, life expectancy was 68 years – now it’s 81. Most of the conditions now treatable were not back then, so people died. Until the late 1970s, premature babies died. Now they survive, many with medical condition due to their incomplete development in the womb, requiring a lifetime of medical care which increases as they age. Successfully treat a 50 or 60 year old with a cardiovascular condition, that person lives on to get something else wrong with them. It’s what Americans call “whack-a-mole”. The Medical-Pharmaceutical-Industrial complex and Governments who intervene in healthcare, have led us all to believe that everything is or should be curable and death eliminated. We collapsed whole societies and economies,… Read more »
Depends which side of the coin you are on, but there will always be a health business. Look at the adverts on various channels for various services that are on offer privately.
Prevent the sun shining or tides changing!
People have always got ill and always will, population increase means more illness.
I’m sure the bollicks that Starmer is talking about is to use ‘pivoting toward prevention’ as an excuse to stop us smoking, drinking, driving, travelling and generally enjoying our lives,
He can go pivot on his middle finger far as I’m concerned!
Prevention = socialists telling other people what to do and trying to control their lives. No thanks, f off, my health is my responsibility, give me my f’ing money back and I will take my chances.
In practice, disease prevention is a pretext for “NHS experts” to issue commandments to members of the general public what they must and mustn’t do because anything else is considered to be too unhealthy for them. For a contrived example, more fanatic lactose intolerants are convinced that milk consumption causes all kinds of serious health issues in adults and hence, it must obviously be prohibited. That milk also usually comes from cows whose plentiful farts are – as everyone who believes in this stuff knows¹ – terribly bad for the climate, banning milk is even more urgently called for. Members of this group might not yet be in the position to issue public health dictats based on their whims and fibs but they certainly badly want to get there, to the join the ranks of the anti-smokers and teetotallers who’ve sort of already achieved that. It’s a pretext because causal links between “unhealty behaviour” and diseases happening 30 years later cannot be established based on our present lack of understanding how human bodies work at the chemical level. It’s only possibly to correlate anecdotes people tell of their past lives with diseases they happened to develop in old age and… Read more »
Preventio – ir gave me a laugh. Try telling that to the diabetic who insists eating do-nuts everyday will be good for him. Or the alcoholic not to drink so much to stave off liver disease. Or the drug addicts, untreated hypertensives who don’t believe what you say about future heart disease or strokes.
Yes, I agree prevention is better than cure but front line workers know that despite all the information you can give to these sort of patients is pointless.
I say this as a smoker and drinker.
One can see this by observation of Nurses in Hospitals. There are very many who are obese, and in danger of joint damage, diabetes, heart disease etc. Do they care? NO! The only way to cure this is a massive stick. It won’t work.
The present government is energetically looking for this massive stick and I hope you’ll enjoy being beaten up with it should they succeed as you’re apparently in favour of the general procedure.
Preventation is not better than cure because cure is real and prevention is a myth. It bears repeating a simple statement hear everyone knows but preciously few people actually believe in down in their hearts: Correlation is not causation. It doesn’t matter how often two things correlate or rather, how much effort people put into generating statistic after statistic showing correlations they wanted to show for outside reasons while ignoring others they don’t want to emphasise such as the bloody obvious phenomenon that serious disease and eventually, death, correlates age, this doesn’t establish a causal link, just the (more or less remote) possibility of one. There was a time not that long ago when lobotomy was considered to be a cure for depression. We don’t do that anymore because it was eventually accepted that it caused great harm for no benefits, however, we still have no idea what depression actually is, let alone how to cure it. But there’s a huge depression management industry selling all kinds of miracle cures ranging from pills whose only certain quality is that they’re addictive while the benefits, if any, are anything but certain, to whole tribes of shamans performing this or that magical… Read more »
I commented on the original of this article, but here is the gist: AI is a phrase used by politicians, but is erroneous in its ability. No computer program has any “intelligence”, they have a rather better memory and search ability than people, and simply decide on facts by their count of references. This is just statistical misuse. You can try it yourself on the available “AI” sites, try asking them to invent something completely new and unknown. Ask one to contrast two very similar views or subjects, their lack of discrimination is instantly revealed.
Sorry Government, this is another very expensive way to chase Unicorns. Just follow the cash, just the same as all unproven computer modelling of chaotic systems.
Somebody posted this link on another article today, excellent read and explains what you are saying
https://www.forbes.com/sites/kalevleetaru/2019/04/20/our-entire-ai-revolution-is-built-on-a-correlation-house-of-cards/
Why can’t any of them simply tell the truth? The NHS has been a basketcase since 1947 when Labour ignored the Tories plan for funding. That was about the only part of the Tory manifesto on the NHS they didn’t use and look where it has got us. The NHS is in no way fit for purpose. What we all individually pay into it should be diverted into private insurance schemes with a guaranteed minimum level for all. The cost to anybody would, therefore, be no higher than it is today. Everyone who is a British citizen would get free care via that insurance. Anyone who is not British is responsible for their own insurance except for, obviously, life or death situations. The work would be carried out by independent companies who would be free to pay Doctors and Nurses what they want to pay them. It’s called The Free Market. In essence it would be similar to how cataract operations work. You see your GP (they would also be independent), you are referred, at most 6 weeks later you have no cataracts. Nobody cares less that it is a private company; they just want rid of the cataracts. I… Read more »
If all those different Governments believed prevention is the answer why didn’t they forego the tax on cigarettes and ban them? Words are simply a jumble of letters when there is no intent and no action.
A real Prime Minister, a real leader, is akin to Elon Musk who comes up with ideas, describes it, gets the best people to implement it and delivers it. No politician I can think of, including the late, great Thatcher can do that. A Musk is exactly what we need, a person who can see the big picture and deliver the things you need.
Prevention via the NHS is a pretext or draconian nanny state-ism. Banning and controlling everything on the grounds it will save the NHS and hence taxpayers money. Centralised record keeping on your every move to ensure you don’t do anything unhealthy which will then be abused. Excuse to bring in ID cards. Suggestion: we privatise it thus encouraging people to take responsibility of their own health or they pay more for their medical insurance.
It’s déjà-vu all over again.
The deadbeats in the 1945 Labour Government reasoned that the NHS giving ‘access’ to all and focussing on prevention would produce a much healthier population requiring diminishing intervention, therefore the cost of the NHS would only increase more or less in line with inflation.
Two years after launch it was costing twice what had been budgeted.
The idiots are still at it, having learnt nothing after 70 years.
If life is extended, people live long enough to get diseases of old age – which cannot be prevented. These diseases are the most costly to treat.
The NHS is corpse walking, put it in the ground and bury it deep.
Privatise medical care; abolish the welfare State. People need to learn to pay for themselves not rely on others, or do without.
Now for a contrary view. The NHS is not broken but it is overwhelmed. The problem is a gradual increase in inflammation which started in the 1960s. Inflammation contributes to all disease and is the reason that a whole range of conditions have increased thhroughout the age range. Those born in the period between 1920 and 1960 are doing OK, and this is the reason that the age standardised mortality has been falling as the young get more and more unhealthy. We need to recognise the cause of the increase in inflammation and set about reducing it. I agree with the authors that prevention as preached to date has not reduced the demand. In fact most so called prevention is early detection and actually increases the demand on the health service. But primary prevention involves doctors giving advice to the population and leaving people to take it or leave it. I assure you that the population will follow what they regard as good advice. It is true that socialists like to ban things. But the best example of prevention is what happened with cot death between 1988 and 1995. The number of deaths fell from 1500 to 500 (Engalnd and… Read more »