Is there a doctor in the house
IN the days of the one-man practice, the village doctor was on call every hour that God made, left medicines for collection in an unlocked box fixed to the wall outside his house, travelled round to see his patients at home and kept their records by hand. The car had replaced the horse and the service was free to all, but, otherwise, healthcare in the countryside hardly changed with the coming of the NHS.
Of course, much of the medicine that is now commonplace was entirely unknown then. Today, from diagnostics to defibrillators, we can pinpoint disease and provide emergency treatment with an accuracy and on a scale that’s unparalleled. Technology has transformed everything from testing to treatment. The centralisation of services and the demise of the cottage hospital were the necessary consequences of technological advances that demanded complex equipment and ever more specialist skills.
The closure of every one of the rural hospitals was fought with gusto and the amalgamation of practices and the centralising of health centres was seen as yet another example of the loss of services in the countryside. We all found it hard to accept that medicine had changed and that, if we wanted modern treatment, we had to have it delivered in this new way.
However, what we did fail to realise was that all that change didn’t make the NHS a national health service. Instead, it remained a National ‘Curing’ Service, almost entirely dedicated to making the ill better. Its preventative role was and is peripheral. New drugs and treatments come in thick and fast, demand rises inexorably and the system strains just to keep up. It seems that we’ve never had the time to pause and consider whether some of the things the NHS does are themselves preventable. Instead, we’ve lurched from curing crisis to curing crisis no matter which political party is in power.
On a recent visit to an agricultural show, Agromenes saw just how much we were ignoring preventable disease. Buggies were carrying visitors too fat to walk, young people were taking advantage of the open air to smoke, fast-food outlets were on every corner and, everywhere, children were clutching sugar-laden soft drinks. At lunch, a specialist told me that the major reason for admitting five year olds to hospital is to take out their milk teeth, already rotten from too much sugar. Without preventative action, those same children will have rotten second teeth.
On the same day came a report showing that 900,000 British people were too fat to work properly. Although unproductive, most of them will be expecting the NHS to cure the conditions that their obesity causes. No wonder diabetes alone is consuming 10% of the entire health budget at a rate of £1.4 million an hour.
And the situation is getting worse. The cost of obesity to the NHS will double over the next 15 years. Curing preventable conditions could therefore be crippling, yet it could also provide a real opportunity to make the present health budget work. If we took prevention seriously, we could save sufficient funds to pay for the new treatments that offer hope to the chronically sick.
The next Government must, therefore, commit itself to a real NHS that prevents as well as cures. That means extensive intervention to combat obesity, improve diets, encourage exercise and further curb smoking. The resistance would be as tough as when the hospitals were consolidated, but the change is just as necessary. We cannot afford to ignore prevention if we’re to have any hope of paying for an NHS that continues to serve both town and countryside.
‘We’ve lurched from curing crisis to curing crisis no matter which political party is in power