Is there a doc­tor in the house

Country Life Every Week - - Letters To The Editor - Fol­low @agromenes on Twit­ter

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

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