ANH-Intl directors Rob Verkerk and Meleni Aldridge discuss this hot topic in the first of their log cabin chats
The NHS is one of the biggest employers in the world. With its 1.7 million employees, it’s been rated the fifth largest globally, coming in behind the US Department of Defense, the Chinese Army, Walmart and McDonalds. Yet the 70-year old behemoth institution is on the brink of collapse and may already be too far gone to save.
Judged sometimes as the best example of a health service in the world, Britain sits at the bottom of the European league tables for some health indicators. The NHS is breaking because pharma’s drug model in tandem with the silos of conventional medicine have been unable to stem the tide of chronic disease, deal with an aging population and the increasing mental health crisis. The NHS is on its knees and remains the subject of heated political and citizen debate in the UK.
The Green Paper has many progressive elements to it, including personalising healthcare, empowering patients to do more self care and take more responsibility for their health, and embedding genomics into healthcare decision-making.
These are things all of us want to see - and, as such, they're components of our sustainable health blueprint. But, as always, the devil's in the detail.
Looking for example at genomics, everything we've seen so far would suggest the NHS will only be looking primarily at what are called high-penetration, serious disease risk genes, of the ilk of BRCA for breast cancer. Thinking does not appear to have moved on to consider how complexes of low-penetration, diet- and lifestyle-mediated genes could feed into personalised wellbeing plans as integrative medicine practitioners are already doing. Updating the NHS Health Check and prioritising screening is high on the agenda, as is type 2 diabetes prevention. But exactly how? Where are very low carb diets going to be in the pecking order - and will GPs and primary care clinics be trained to help people develop metabolic flexibility? Probably not, any time soon.
Turning all the talk into action, the target is to ensure that one million people in the UK should benefit from social prescribing by 2023/24 and there’s to be more focus on children and a healthy child programme. All sounding very promising until you hear that alongside toothbrushing, PHE are still pushing fluoridation! Two steps forward and one back. Whilst disease prevention is starting to climb up the agenda, there is still a way to go.
One of the biggest claimed successes has been the integration of health and social care, as proposed by the Health and Social Care Act 2012. But let's not confuse this kind of integration with integrative medicine - and we say this because it seems that some in the medical mainstream are confused.
More good news is that there is every intention to focus more on health span, as compared to life span, not least because lifespan has plateaued (through most of the Western world) and the number of healthy years lived by most has been shortening as more and more of us succumb not to one, but to multiple, often related, conditions. The burgeoning digital tech market is viewed as the saviour to help motivate, incentivise and track citizens along their health journeys. There is a new digital strategy for the NHS, which includes major and soon-to-be-released updates and improvements to the NHS App that should allow all patients to have access to all their medical records, any time any place. It’s clearly the cherry on the health prevention cake at the moment and viewed as a game changer for public health in the UK. We shall see.
Bridging the gaping chasm between public health and functional/integrative/natural medicine is where our blueprint project really comes into its own. Our sustainable health system is about looking at what can be done outside the myriad structures of the NHS to build an effective, proactive, sustainable and more natural (fluoride-free!) system of healthcare in communities.
We fully acknowledge that there’s no quick way of turning a GP who’s seeing 40 to 60 patients a day, essentially firefighting complex diseases with drugs that mainly mask symptoms – to someone who’s working in a collaborative team to help guide citizens on their health journeys. The need for new and different forms of training and professional development, the seismic change in attitude, the organisational changes, and, last but not least, decoupling not only doctors, but also the public, from the 'pill for an ill model', is not something that happens overnight.
But changing the conversation from disease management to disease prevention is definitely a good start.