The UK government has largely ignored lessons to be learnt from 60 years of NHS reorganisation leading to failures in the system, argues professor David Hunter, a professor of health policy and management with Durham University.
In his book, The Health Debate, to be published by at the University of Bristol, he analyses the challenges faced by the NHS.
The NHS has subsequently evolved into a "sickness system" primarily designed to repair those who fall ill and doing little to promote or improve health, says professor Hunter. Yet the government now needs to take major, well-informed action if it is to control health problems like obesity and reduce the massive burden on the health system.
He said: "One of the curious ironies of the NHS, and many other health systems like it, is that it does not pay enough attention to health, focusing instead on ill-health and disease. The NHS diagnoses and treats rather than predicts and prevents.
"The government needs to shift this balance as the increasing cost of lifestyle-related diseases, such as diabetes, obesity and some forms of cancer, will prove financially unsustainable making the NHS unaffordable.
"Changing people's behaviour is difficult and merely giving people information and advice is known to be ineffective. It needs for the government to take bold action to control rising obesity levels and other health problems. Yet, government does not want to be accused of being the 'nanny state' and is reluctant to act on some of the determinants of ill-health.
"Bold action on the part of the government should include taking tough action to control levels of fat, sugar and salt in foods, as well as trying to narrow the income gap between rich and poor."
Do you agree with professor Hunter? Has the NHS evolved into a "sickness system"? Your comments: (Terms and conditions apply)
"The problem is that the NHS works to a 'medical model' and patients expect a drug cure when they should be addressing their lifestyle and nutrition to prevent diseases. Most modern, western hemisphere ailments are due to physical inactivity and overeating/drinking." - Pam Fry, Berkshire
"I agree. I work in general practice providing a minor illness and triage service. A number of people expect the NHS to provide hand and skin creams that are cheap to purchase, antihistamines for insect bites, paracetamols for colds, etc - those conditions that can be easily managed by themselves. Taking up appointments is increasing everyday. We also have a particular problem with individuals who have just moved here from other countries who attend the GP and demand often expensive interventions and investigations, as well as medications for self-limiting conditions. They are told it's all free. Maybe we should rethink the 'free' bit - if it can be managed cheaply then it shouldn't be free. Common sense is definitely lacking. The 'nanny state' is perpetuated by this notion that the NHS is 'free', yet it is a costly service which is abused." - Name and address supplied
"Yes I do agree to a certain extent. I work in a walk-in centre and Dr OOH service, and I struggle to find anything wrong with the vast majority of patients that come through our doors, making it difficult for people with real urgent and emergent cases to be dealt with. Changing behaviour also should come hand in hand with taking responsibility for themselves and their families. There is more information resources out there than ever before, yet demand is growing year in, year out. We cannot simply keep throwing leaflets at people. The public must take their share of the responsibility as this percentage increase every year cannot be sustained. We are struggling with budgets, targets and dwindling staff levels and yet the government and public expectations are rising to unsustainable levels. There is a lack of common sense out there, and the government must do something to alleviate relative poverty with low wages and lack of housing for people to be able to take proper control of their lives. This is not being a 'nanny state' - it is simply distributing resources more fairly." - Name and address supplied
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