Nigel’s Notes - Prevention is better than cure

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Perceived problem: plastic bags get blown around and are a major cause of litter; they are not biodegradable and are therefore an ecological problem.

Proposed solution: make folk pay for getting a plastic bag in a shop and they will use fewer. Legislation was passed in Scotland last year. Effect: the use of plastic bags has reduced by 80%. “Simples”. Next problem please.

The NHS in Scotland is struggling to meet its targets; its budget will continue to be constrained by prevailing economic conditions; and demands are bound to rise as the population ages and life expectancy increases. The detail of this can be found in a very recent report from the Auditor General for Scotland. Proposed solutions: find someone to blame, make unreasonable promises, bury head in sand, muddle through in the short term and retire before the worst arrives.

It is incredibly easy to blame the government – and for opposition parties to assert that they would do better. Unfortunately the Auditor General’s report offers little scope for this approach. Changing the targets does not significantly affect performance and telling folk to try harder does not help at all. There are actually three aspects to the problem. Firstly our collective aspirations are unrealistic: we expect to live longer without having to take care of ourselves and expect the NHS to deal with all our ailments without delay. We reckon that we’ve paid our taxes and we’ve been promised that treatment will be available within some time frame or other, and – because it is comfortable – we believe everything should and will work out. Secondly we resist change: although we will acknowledge that delivery systems will have to move with the times, technology and demographics those changes had better not be at our local GP practice or community hospital. Aye things must change, but not in my home town. And thirdly we ignore the fact that there are not and never will be enough trained people to staff the health service we would like, even assuming we could afford to pay them.

Governments can do a few things. Firstly they can encourage the NHS towards prevention rather than cure, and a good example is the recent announcement about investment in preventative surgery like hip replacements which allow patients to remain active and thereby reduce the risk of many other problems developing. Secondly we can train more people and an increase in the number of training places for GPs is planned. Thirdly a greater flexibility in between-year accounting would help health boards make longer term decisions which will ultimately make greater savings. Additional borrowing powers for the Scottish Parliament will help that to happen. But fundamentally the answer lies in our own hands; do we want to make the effort to be and stay healthy?

Let’s be clear that we do not all have the option, and recognise that there are folk with serious conditions which they did not bring upon themselves and could not have prevented. They need our support and all the care the NHS can give them. But the rest of us can do more to look after ourselves. It’s about what we eat and drink, how much exercise we take and what the combination does to our waist lines. We know the answers – it’s just difficult to accept personal responsibility, and that’s why if we are not careful we’ll carry on blaming politicians or the HNS staff themselves for not meeting our collective unrealistic aspirations.