Vital steps to move the NHS from cure to prevention
Historically, doctors gain an identity that is grounded in the sanctity of the 'clinic' (primarily the hospital) as a well-patrolled territory with idiosyncratic rituals and language. Patients are kept on the other side of the fence. Medical education traditionally affords little work-based experience in the first two years, but after that students gain increasing exposure to clinical work. However, this is largely focused on secondary care (hospital and clinic) settings, and on cure rather than prevention.
Medical students soon learn that their professional identity construction depends on strict separation from community-based practices such as social work as they identify with the curative rituals of the clinic. Healthcare as a whole will not be able to focus on prevention, as Wes Streeting wishes, until medical students' miseducation into the sanctity of clinical cure is addressed. This is a pedagogical challenge that must no longer pass under the radar.Dr Alan BleakleyEmeritus professor, Peninsula school of medicine, University of Plymouth
Of course Denis Campbell is right to say that moving the NHS from treatment to prevention is a great idea. The problem is, and has been for years, that finding the money for preventing ill health is apparently impossible while the NHS still has to treat ill health that wasn't prevented. Treasury rules seem to forbid investing for future savings.Christina BaronFormer NHS trust chair
Your report (29 June) on 'medieval' levels of healthcare inequality affecting the poorest sections of society is borne out by the National Diabetes Foot Care Report 2022 for England. This found that people with diabetes living in the most deprived areas of England are 82% more likely to undergo a major amputation than those in the least deprived. Such a predisposition to major amputation in the circumstances of poverty contributes to a postcode lottery with a 4.8-fold variation in major amputation rates, ranging from 3.5 to 16.8 amputations per 10,000 population with diabetes per year.
People in deprived areas face economic and social barriers to care and restricted referral pathways, resulting in delayed access to specialist care. They are then too late for conventional treatment and require amputation, with all the suffering, costs and life-changing effects these have. Thus the income and home address of people living with diabetes can contribute significantly to whether they lose or keep their legs.
However, it should be possible to prevent most major amputations. Such an aspiration is in keeping with the preventive ethos of the 10-year NHS plan, which it is hoped will facilitate more rapid and equitable access to initial care in the community and prevent amputations in all people living with diabetes.Prof Michael Edmonds, Jonathan Hunt (patient), Dr Erika Vainieri and Dr Chris ManuKing's College Hospital, London
The excellent Black report on inequalities in health was commissioned by Labour in 1977 and published in 1980, by which time the Tories were in government and the report was marginalised and ultimately dismissed by them. The report recommended improvements in child benefits, childcare allowances, preschool education, school milk and meals, disablement allowances, housing and working conditions. Nothing new there, then. We know what needs to be done to make the quality of life more equal for all of us. Anyone who lives in or is familiar with those parts of the north (and elsewhere) suffering extreme deprivation knows that things must change. The situation is intolerable. It is a blight on our so-called civilised society.Val CooperLondon
The ministerial U-turn on planned health-related benefit reforms included a welcome pledge to 'listen'. They would do well to study the link between deprivation and the 'lifestyle diseases' arising from obesity, smoking and excessive alcohol consumption. As well as explaining the 11-year life expectancy gap between the most and least deprived parts of the country, it is a vital but often overlooked factor in the debate over health and disability benefits.
My research reveals that people in the poorest communities typically experience poor health up to 21 years earlier than those in richer areas. In Blackpool, for instance, 'healthy life expectancy' is just 53.5 years, compared to 74.7 years in Rutland. People in Blackpool are therefore far more likely to leave the workforce before state pension age – and therefore claim health and disability benefits – than those in Rutland.
The government must pursue a longer-term approach to curb the rising welfare costs of poor health and disability. We need a comprehensive public health strategy to tackle the root causes of premature poor health. For too long successive governments have shied away from bold actions around smoking, obesity and alcohol to significantly improve public health.Prof Les MayhewCity St George's, University of London
Have an opinion on anything you've read in the Guardian today? Please email us your letter and it will be considered for publication in our letters section.
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
South Wales Argus
an hour ago
- South Wales Argus
Liza Collins on the meaning of relational leadership in NHS
It was inspiring, but many were left wondering: what does that actually mean in practice, especially on a busy NHS ward or in an overstretched community team? Relational leadership is more than a buzzword. It's a mindset and a practice, one that might just hold the key to a healthier future for our NHS teams. At its heart, relational leadership is about how we show up in relationships at work. Not as titles, hierarchies or roles, but as people. It asks us to move beyond command-and-control styles and towards connection, curiosity and care. To lead with both clarity and compassion. To listen more. To build trust and rebuild it when it's broken. That may sound idealistic, but the evidence tells us otherwise. Teams thrive when people feel safe to speak up. They perform better, innovate more and recover faster from setbacks. This is what psychological safety looks like: an environment where you can share ideas or admit mistakes without fear. But here's the catch: it does not happen by accident. It is created, moment by moment, through how we treat one another. A good relational leader is not always the loudest or most confident voice in the room. They are often the most consistent. They notice the tone. They welcome feedback. They understand that a difficult conversation handled well is a form of leadership. They recognise that it takes time to build trust, and only a moment to lose it. When leadership is too harsh, trust is lost. When it's too absent, people flounder. Relational leadership strikes the balance, with clear boundaries and human connection. In the NHS, we already understand relational care. We know the difference a kind word or a thoughtful gesture makes. The challenge now is to extend that same humanity into how we lead. Because the truth is, we do not change workplace culture by policy alone. We change it through everyday relationships. So, if we want a thriving NHS for the future, we must ask: what kind of leaders, and teammates, are we choosing to be? Liza Collins, MA, FRSA NHS Culture Strategist and Future of Healthcare Executive Leadership Coach
Daily Mail
an hour ago
- Daily Mail
Weight-loss drugs are RUINING the nation's dinner parties, furious hosts warn
Weight-loss drugs are ruining the nation's dinner parties, according to a survey of frustrated hosts. An estimated 1.5 million Britons are now using wonder drugs such as Ozempic, Mounjaro or Wegovy. But new research suggests it is taking its toll on the nation's traditional dinner parties - and hosts are understandably not happy. Nearly three in ten (29 per cent) Brits who have recently thrown a soiree say they have been annoyed at having cooked a delicious meal, only for guests to push food around their plate. A resounding six in then believe the correct etiquette is to call ahead or text, to let people know if you are taking weight-loss drugs, so hosts can amend the menu accordingly. The survey, of 2,000 frequent dinner party hosts and attendees, found lighter options, such as a small prawn cocktail (21 per cent) melon and prosciutto (15 per cent), fish soup (13 per cent) or a small fillet steak with some simple greens (18 per cent) are the most suitable Ozempic dinner party options. While 14 per cent of hosts say a sorbet makes a good choice of pudding, and to start, rather than filling appetisers, some crudités and dips (14 per cent) Of those who are on the drugs, as many as 80 per cent agree, they now find the social side of eating and drinking uncomfortable. Nearly half (47 per cent) say that they have ruined their enjoyment of dinner parties entirely. Almost a quarter (22 per cent) have offended a host by being unable to eat the food they'd prepared, while one in ten have even hidden food in a napkin at someone's house to avoid embarrassment. And it's not just food that's spoiled, with 18 per cent saying that they can no longer enjoy nice wine or cocktails. Jion Horsley, from trends and insights agency Perspectus Global, which carried out the survey, said: 'Weight-loss drugs may be the cure for obesity that we've been looking for, for decades.' 'But we're still in the early days of their use and they will have ripple effects which we won't be aware of yet. 'The fact that their use can make social eating difficult is just one unforeseen effect. 'This research proves that shared meals may become more awkward until we work past the social difficulties, adapt our menus and the etiquette surrounding the subject'.
Times
an hour ago
- Times
Times letters: Long-term fixes for the failures of the NHS
Sir, While there is much to like in the ten-year plan for the NHS ('NHS app to give patients a 'doctor in your pocket'', news; 'Sacred Cow', leading article, Jul 4) nobody will be convinced by it without the government providing specific annual milestones for internal project management, and by which the public can judge whether after ten years the plan is likely to have been achieved. If the government is itself convinced that the plan is a good one, it will already have worked out what it needs to achieve in the next 12 months to make sure the plan is on track, and of course in each year thereafter. Maybe the government should consider publishing what the milestones are so it can show the public real progress is being made. If it doesn't, one can only assume that it is not confident that it will achieve its milestones (or worse, hasn't yet decided what they are). Alistair Groom East Martin, Hampshire Sir, The prime minister talks about the NHS app as a 'doctor in your pocket' and the 168-page heath plan makes many references to using AI to answer clinical questions. This seems replete with risk. When an NHS AI gives poor advice, who is liable? In its principles for AI policy document, the BMA strongly advises that 'clear lines of legal liability must be established'. The NHS plan makes no mention of who is to blame when these systems make mistakes. Does the health secretary have an answer for this — or I should I ask Dr Google? Dr Tom Riddington London SE12 Sir, The NHS app will not be 'an indispensable part of life' for me or my wife, both in our seventies, or for others like us, who do not have smartphones. In a world that puts diversity and inclusiveness at a premium, we are finding ourselves more and more excluded from things that others take for granted. John Orton Bristol Sir, My husband's cancer treatment has involved three hospitals and many departments within those hospitals. I endorse what Wes Streeting says about the need for medical data to be easily accessible ('We will end 8am scramble for a GP', Jul 4). Staff do not have all my husband's information in one place and it has been exhausting having continually to explain the side-effects, treatment and what my husband needs at every appointment, including emergency admissions. We are still reasonably articulate but we wonder what happens to those who are not able to fight their corner. The staff themselves have been wonderful and I am sure the situation is as frustrating for them as it is for us. Cynthia Blades Chichester, West Sussex Sir, How can the government claim its health plan will 'prevent sickness' when a proposal to warn people of the health risks of alcohol, the second biggest cause of death and disability among working-age people, are watered down after 'a furious response from the industry' (news, Jul 2)? Who is running this country? The elected government or the unelected drinks industry? Glyn Sloman Holt, Norfolk Sir, A more efficient, technologically adept NHS, less hospital-based and where information is more easily accessed is an essential part of the solution to our problems. But it must be combined with people taking greater responsibility for their health, including diet, exercise and cutting down on smoking and drinking. Tony Hunter Former chief executive, Social Care Institute for Excellence, Woodford, Essex Sir, Your reference to Rachel Reeves ('Tears on front bench were a personal matter', Jul 3) highlights how uncomfortable the British still are with public displays of emotion. Crying isn't a sign of weakness, but the physical manifestation of emotional turmoil. We should all learn to be more understanding. Following the death of our eldest child in 2016 I frequently cried in public. This often resulted in fellow passengers — exclusively men — changing seats without saying a word or pedestrians crossing the road to avoid me. If you really want to make your fellow man uncomfortable, crying while using a public urinal at the local supermarket will clear the room quicker than you can say Jack Robinson. Richard Houghton Great Missenden, Bucks Sir, The correspondence from your readers on Sir Keir Starmer's leadership (letters, Jul 3) is all focused on finger pointing. Not a single constructive suggestion is made. We live in an age where the sheer volume and speed of events both nationally and internationally comes dangerously close to making conventional governance impossible. This is the perfect Petri dish for the incubation of demagoguery and dictatorships. We should be more prepared to support our elected leaders. Nicholas Oppenheim London SW6 Sir, I am one of those consultants who has left the NHS to work exclusively in the private sector (letters, Jul 3 & 4). At the age of 62 I fear what this government may do to my pension and have, therefore, taken it early. It also means I can continue to strive to practise medicine to the highest standards and not have to engage in what I perceive as the NHS drive to reduce everything to the lowest common denominator. My wife, a GP of 35 years, and I fear there will be no one left to look after us in our old age. Simon Marsh Consultant surgeon, Ipswich, Suffolk Sir, It is baffling why Fraser Nelson's article on the welfare trap and the easy solution he outlines is not being adopted by Labour ('How Liz Kendall can stop this national sickness', comment, Jun 28). Allowing — indeed almost encouraging — the young to game the system as it stands exacerbates any underlying mental health problems. There is a mass of evidence to suggest that employment is good for mental health. Meanwhile, there is a desperate need for people to work in the building trade if we are to get anywhere close to Labour's target of building 1.5 million houses over the life of this parliament. Instead of signing people off sick, give them an incentive to train as plumbers, electricians or any other of the skills required by housebuilders. Reversing the national insurance rise for people under 25 to encourage employers to take them on would provide a further incentive. Andrew ScottSalisbury, Wilts Sir, Emma Duncan's thoughtful piece on entitlement (comment, Jul 4) omits the stark difference between the political and the personal. I can agree politically that the welfare costs are out of control but personally I do not want the personal independence payment taken away from my granddaughter. In the same way, while it is obvious that paying ransoms encourages kidnapping, you would pay anything for the release of a family member in such a situation. Gillian Fogg Surbiton Sir, Orcas have been known for their interaction with humans for many years ('Killer whales come bearing gifts', Jul 4). A pod of them, known as 'the killers of Eden', operated in Twofold Bay, southeast Australia, for about 90 years from 1840. They helped baleen whale hunters by finding the whales, herding them into the bay and alerting the whalers to their presence. In return, the whalers would share the whales' tongues and lips with the orcas. Nicky Gill Richmond, Surrey Sir, My late father always assumed that gratitude had prompted a gift of food from an injured buzzard that he had nursed back to health. Shortly after its release back into the wild the buzzard reappeared carrying a dead mouse, placing it carefully on my father's shoulder. My mother was always most grateful that the gift to the family wasn't delivered to her. Caroline Tayler Nutley, East Sussex Sir, I have been following the tennis at Wimbledon and wonder whether the authorities could bring in a limit on the number of times a server bounces the ball before serving. It is an unnecessary and irritating habit. Just get on with the game. Diana Barrington Holt Lambourn, Berks Sir, I would happily have taken sandwiches to work had there been a staff room or somewhere suitable in the locality to eat them (letters, Jul 3 & 4). In the 1950s bank managers were required to live above their branches. The only facility for staff at my branch was a single lavatory. Later generations have no idea of the hardships undergone by those who lived through the Second World War and its aftermath. The country was bankrupt. 'Export or die' was the slogan, so there were no cars for the home market and most things were in short supply. Strict building controls were imposed to ensure priority was given to the war-damaged in the 1960s did matters improve. Robert Spratt Upton St Leonards, Glos Sir, The 'canard that bankers in the past worked only from 10am to 3pm' was nailed by Jerome K Jerome in Three Men in a Boat (1889), in which he describes how 'George goes to sleep at a bank from ten to four each day, except Saturdays, when they wake him up and put him outside at two'. Dr John Burscough Brigg, N Lincs Sir, I was amused by Deborah Ross's article about celebrities' rosé wines (Times2, Jul 3). Rosé was once a pleasant summery wine with an attractive light red colour and the ability not to give one a thumping headache on a hot day, all for a reasonable cost and without being pretentious. Suddenly it has morphed into an overhyped weedy looking light pink concoction barely distinguishable from cheap white and puffed by celebrities pushing their own particular labels. Where are the robust Côtes de Provence of yesterday? Martin J Eames Caterham, Surrey Sir, Why are we obsessed with keeping British art in this country, raising huge sums to do so (Richard Morrison, Times2, Jul 4)? If people want to buy it, be proud of that, don't stop them. Our art is hugely undervalued abroad. Let the world see it. The more it leaves this country, the better for Britain. Anthony Jennings London WC1 Sir, If it is possible to decommission the royal train because the royal family no longer use it (letters, Jul 3 & 4) is it not also possible to decommission the titles still used by the King's youngest son on the basis that he (and his wife) are no longer of any discernible use to the people of this country? Rob Green Braintree, Essex Sir, I notice with some amusement, and indeed amazement, that there were two letters to the editor on the same day from Hartley Wintney in Hampshire (Jul 3). Is this a record? Sophia Bennett Hartley Wintney, Hants Write to letters@
