How paternalistic can liberals be in promoting health?

Monday, 19 November 2007 12:00 AM

Norman Lamb, Lib Dem health spokesman, argues the NHS must shift its emphasis to promoting wellness rather than curing sickness.

Public Health is not just a problem for individuals. Obesity, sexually transmitted diseases and substance misuses are not just personal issues - they have wider societal causes and impacts. NICE estimated the indirect cost of obesity to the NHS at around £1.8 billion per year. Similar figures for smoking (£1.5 billion) and alcohol abuse (£1.7 billion, in addition to £7.3 billion in costs relating to alcohol-related crime) highlight the scale of the problem. With the UK suffering some of the highest rates of alcohol-related illnesses, obesity, sexually transmitted diseases and teenage pregnancy in Europe, we are stoking up a financial crisis for the NHS.

The Wanless report in 2004 noted that the promotion of healthy lifestyles and the prevention of disease should be 'central' to the work of the NHS. However, the way in which the NHS is funded and the mania for targets means that the NHS is better described as a 'National Sickness Service' rather than a National Health Service.

Public health budgets have been left at the mercy of penniless NHS Managers as funds are diverted to help meet short-term financial pressures. It is striking - but sadly not surprising - that 66 per cent of the 2006-07 Choosing Health allocation, according to research by the Association of Directors of Public Health, was used not to tackle obesity, smoking or alcohol abuse, but rather moved to cover deficits. The full legacy of these short-term 'soft target' cutbacks will only be fully realised over a period of decades; perhaps long after the present government have relinquished the reigns of power.

The Liberal Democrats believe in creating an NHS which is more responsive and accountable to the people it serves. A vital part of this process entails enabling people to take positive decisions about their health through access to information and services. Clearer food and alcohol labelling, for example, is not a behavioural dictat from Whitehall, but a positive step towards empowering the purchaser to make an informed choice.

There also needs to be incentives at the supply side. Medical professionals need to encourage their patients to look after themselves, but this will not happen if they are excessively constrained by government targets and disincentives to pay consideration to the longer-term.

The situation in NHS dentistry is a prime example of this. The way the 'Units of Dental Activity' (UDA) payment system operates gives no impetus to preventative work. Instead dentists are incentivised by a crude system of payment per UDA, hand in hand with minimum government targets. On top of this, patients also face charges for regular check-ups. These should be abolished. The emphasis must be on health as much as cures.

The Liberal Democrats believe that more responsibility should be transferred to the local level, to both the patient and the practitioner. If we can empower communities by letting them take the key decisions, we will be better placed to improve the public health of the nation.

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