NHS at risk of becoming ‘unsustainable’
The government needs to change the way it tackles unhealthy behaviour such as smoking, alcohol misuse and obesity or it runs the risk of the NHS becoming unsustainable.
The NHS and Primary Care Trust’s (PCT’s) have been told by the Department of Health (DoH) they must take the lead on supporting changes in behaviour and promoting a healthier life style, but the actions taken are not enough according to a report published today by the King’s Fund.
Norman Lamb, Liberal Democrat health spokesman, said: “Unless the government is more effective in tackling these massive challenges, the cost of obesity and tobacco-related illnesses will be disastrous for individuals and will bankrupt our health service.”
Unhealthy behaviour and illnesses contribute a significant proportion of the burden faced by the NHS when dealing with disease and come at a massive financial cost – which could rise continuously and potentially bankrupt the NHS.
The NHS currently spends £6 billion on treating the effects of unhealthy lifestyles and supporting people to change their habits.
Sir Derek Wanless of the King’s Fund said: “If action is not taken, the financial cost to the NHS will grow and could make the NHS itself unsustainable. This is why investing in effective behaviour change interventions is more important than ever.”
The report found significant changes to the way the NHS and PCTs tackle behaviour need to be made in order to really help people and lower costs.
Behaviour change is a long term process and the NHS and PCT must commit to this long term approach and also recognise that the techniques used are not transferable to all aspects of behaviour change, the report argued.
A greater emphasis needs to be placed at a local level, it continues. Local health services need the freedom to monitor and target the people that live in their communities as social factors play a large part in those who pursue and maintain unhealthy lifestyles.
The use of geodemographics – the science of profiling people by where they live used by commercial marketing – can be used to give an insight for local health workers on the needs and behaviours of the people they are treating.
Investment into these techniques should be made so staff can know their communities and tailor their approaches to deal with cases more specifically. The process of behaviour change if far too complex to be blanketed over the country as a whole, the report argues.
The government strategy of providing information to people and increasing public awareness of the problems has also not been totally effective.
According to the report, this is because the process of change is determined by more than a person’s knowledge. The DoH spent £50 million between 2007 and 2008 on information based projects
Unhealthy behaviour is strongly linked to those from low-income backgrounds and from ethnic minorities. Smoking and obesity remain some of the biggest causes of the substantial and growing inequalities in health between high and low income groups.
One measure that the report believes should be used is the inclusion of financial incentives to help people change their lifestyles.
Monetary encouragement has been successful in local areas like Dundee where pregnant women were given £50 ASDA credit each month if they passed a carbon monoxide breath test. This scheme helped 50 out of 55 women stop smoking and cost a total of £6000, which is very cost effective.
This technique will be ineffective if used on its own, the authors argued. Non financial incentives must also be implemented, such as giving children fruit for break times, giving the individual more support, the use of health coaches, and relaxation strategies.
The NHS should also put into place a process that will enable them to evaluate the impact of the measures, to compensate for a lack of good-quality evidence. This information, if shared, would help to identify what works for whom and make the process of change more effective and efficient.
“Britain has the most obese and overweight population in Europe and one of the worst alcohol problems in the world,” Mr Lamb added.
“The government needs to stop hectoring people about their lifestyles and help them to become healthier instead.”
The government is currently formulating an NHS constitution, which was included in last week’s Queen’s Speech.
