Service ‘just one part’ of how people’s health is maintained

Essex-born Cambridge University graduate Dr Margaret Hannah, 56, has been Fife’s consultant in public health since 1996.

She has seen astonishing advances in health care, but she warns that as medical science evolves, so too does the pattern of disease.

Dr Hannah’s decision to study medicine was influenced by her mother’s experiences as a nurse during the early years of antibiotics, and her civil servant father undergoing a pioneering and ultimately lifesaving fibre optic brain tumour operation on the NHS in the mid-1970s.

But those early technological breakthroughs almost pale into insignificance compared with some of the developments she has experienced as a health care professional since.

The development of fibre optic knee surgery; IVF for infertile couples in the 1980s; life-saving developments in transplant surgery and the ability to save the lives of low birth weight babies are just some examples.

Wider post-war public health improvements including the vaccination of children, better nutrition and housing conditions, cleaner air and water, the expansion of literacy and education and the development of workplace health and safety, mean the UK population has generally been living longer and healthier than ever before.

Yet the rapid progress seen over the last 70 years has come at a price, with lifestyle diseases such as cancers and diabetes on the rise, the demands of an ageing population taking their toll on resources and the amazing drugs and technologies available becoming increasingly expensive.

It has meant that health professionals have to search for increasingly innovative solutions with some potentially difficult decisions about the delivery of care.

There’s an ongoing re-think, for example, of how the rising number of older people can have their stays reduced in acute hospitals, and a greater realisation that patients benefit from care in the comfortable surroundings of home during the last decades of life.

Realistic Medicine, launched by Scotland’s Chief Medical Officer, is shifting health professionals’ focus from “doing more to doing things better and more effectively.”

It’s now recognised, for example, that putting patients on more than five medications at one time is likely to have a detrimental impact on health. In future “shared decision making” between patient and medical professionals about the potential benefits or hazards of a treatment will become more commonplace.

But Dr Hannah says it’s important to understand the NHS is only one part of how the population’s health is maintained. The pressures of an ageing population are being felt throughout the western world and many of the issues raised are felt across the sectors, including housing, social care and public transport.

As medical technology gets ever more sophisticated, so too does disease.

“What we are faced with now is a changed pattern of disease,” said Dr Hannah. “It’s just a case of the NHS not moving fast enough to adapt to that. This is the century of biotechnology – we haven’t seen the half of it yet, but it shouldn’t ever be forgotten that the NHS is fundamentally a human system with patients at the heart. That should never be lost sight of as the NHS moves forward.”

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What we are faced with now is a changed pattern of disease. It’s just a case of the NHS not moving fast enough to adapt to that