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Preventative medicine or backdoor private healthcare?

The push to move responsibility for our health onto our personal lifestyle choices is increasing – but all the evidence about growing inequality shows that traditional in-hospital care is absolutely vital, explains HELEN O’CONNOR

THE illusion that good health comes from within individuals and is entirely based on the choices individuals make is not only false, it is paving the way for NHS hospitals to be removed from local communities.

Assumptions are made that absolutely anyone can enjoy good health if only they tried a bit harder, spent more money on courses, therapy, gym memberships or special diets. Health policy is being developed and implemented around these ideas.

While there is truth in the fact that lifestyle choices can lead to good health for some, this is only half the story. Human health, like everything else, is firmly rooted in material reality — and multiple factors, including environmental conditions, play a role in determining health outcomes.

Everyone is on a different point on the health spectrum and as a general rule those who enjoy better living and working conditions enjoy better health and longer lives.

Wellbeing packages, hubs offering testing and social prescribing aimed around prevention will work very well for the more affluent layers of society.

However those who have already developed severe and chronic ill health or disability are far less likely to benefit from the light-touch solutions offered by preventative medicine.

Ideas about shifting healthcare away from hospitals and closer to home are not new and have been part of health policy for more than three decades.

It started with the closures of the big psychiatric institutions at the end of the 1980s.

These institutions were far from ideal and most reasonable people accepted that progressive changes were needed within a mental health system which was often abusive.

However, as patients were enthustically shipped out into community settings, they suffered badly from the lack of investment in resources and an over-reliance on residential housing provided by the private sector.

Ron Coleman in his book Recovery: An Alien Concept? outlines how people with a diagnosis of schizophrenia were neglected and left to die in doss houses up and down the country.

Costs escalated and some chronically unwell patients ended up being repeatedly admitted to acute units and locked wards because councils were forced to put budgets first when choosing residential placements.

These “revolving-door patients” never have a chance to recover from the life-disrupting process of repeated admissions to hospital.

Relatives were and are left carrying most of the risks and burden of care. This has become worse as even more in-patient beds, units and community services are shut down.

Research by the King’s Fund think tank reveals that the largest reduction in bed numbers over the last 30 years has occurred in mental health and learning disability services.

While the wellbeing market is booming and a mind-boggling array of short courses of therapy, including CBT and mindfulness, are available in both the public and private sector, the poorest and the most vulnerable mentally ill people are left high and dry.

These groups are most reliant on the local hospitals that politicians are keen to get rid of via reform.

It’s boom time for the pharmecuticals industry too, as common mental problems become medicalised and six million people in this country are now prescribed anti-depressants.

In the meantime those patients with severe and enduring mental illness are being dispatched all over the country to private facilites that are both costly and inadequate.

Years of reform, restructuring and cuts to the NHS have already led to Britain having the lowest numbers of hospital beds and fewer doctors than the rest of Europe.

Figures from the King’s Fund reveal that over the last 30 years the total number of NHS beds has halved from 299,000 to 141,000 in 2019.

This leads to overoccupancy, operations being cancelled, overcrowding, breaches of safety protocols and increases the risk of cross-infection.

It means that people with chronic and complex health conditions find that when they are directed to their community hub they can have a very long wait to get the care and treatment they need to alleviate their suffering.

Government figures reveal that during the pandemic, life expectancy fell everywhere but went down furthest in the most deprived areas of the country.

Figures from the World Economic Forum 2021 show that Covid-19 has increased inequality between the richest and the poorest and Britain has one of the highest inequality gaps of any developed country.

The impact of poverty, malnutrition and living in cold, damp housing conditions causes and exacerbates disease and ill-health.

Research presented by the British Medical Journal in 2017 concluded that those living in poverty are three times more likely to develop mental illness and that children living in poverty are more likely to suffer from chronic disease and diet-related problems.

There is little doubt that the poorest in this country will already have developed chronic and enduring illness that requires complex long-term care and treatment if they are to stand a chance of recovery.

We cannot even hope that the NHS of the future can be entirely based on preventative medicine.

Research by Loughborough University 2021 found that that more than 4.3 million children are now growing up in poverty, a figure that had dramatically increased by 500,000 over a five-year period.

What this means is that a significant and growing proportion of the next generation will also develop chronic ill-health and they too will need a healthcare service that have the capacity to treat very sick people.

The children born into the worst conditions always constitute the majority of those who end up homeless, struggling with addiction or incarcerated in psychiatric hospitals and prisons when they grow up.

Living under these conditions will inevitably have a further adverse effect on the overall health of these layers of the population.

The health service should certainly offer testing, prevention and short-term treatments, but imbalance is developing and the most unwell are losing out.

The NHS is being stripped of its capacity to offer comprehensive care and treatment to the sickest, the injured and the most vulnerable in society.

NHS reform based on ill-defined, idealistic notions of “wellbeing” will put the most vulnerable people at risk if these ideas are deployed with the intention of closing more local hospitals.

Sickness and ill-health are on the rise in this country because growing numbers of people are being plunged into poverty.

Many are enduring workplace conditions that will break their mental and physical health as cuts and privatisation accelerates and the gig economy flourishes.

No main political party has a serious plan to reverse poverty or tackle the root causes of serious and enduring illness and this is why we are not yet at a point where we can accept ideas that the NHS can shift even further towards preventative medicine.

Prevention for some but not for all completely contradicts Nye Bevan’s vision of a fully comprehensive NHS for everyone regardless of the ability to pay.

The present climate of escalating poverty levels means that any grand declarations that the NHS should no longer be a service for the sick are a complete and utter fantasy.

If local hospitals continue to be swapped out for hubs and diagnostics run by public-private partnership schemes, a financial windfall will be created for the private sector while accelerating death by a thousand cuts.

Helen O’Connor is GMB Southern regional organiser.


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